Challenging Crohn's Disease: Surgical Complexity and Outcomes in Colonic vs Non-Colonic Resections in a Large Single-Centre Cohort.
Colonic resection in Crohn's disease is associated with higher postoperative complication rates
Challenging Crohn's Disease: Surgical Complexity and Outcomes in Colonic vs Non-Colonic Resections in a Large Single-Centre Cohort.
The surgical management of colonic Crohn's disease (CD) remains controversial, with segmental resections possibly associated with a higher rate of recurrence and postoperative complications, while total proctocolectomy reduces recurrence but increases the risk of permanent stoma formation.
This study compares surgical outcomes and complications in CD patients undergoing colonic resections (any colectomy with or without concomitant ileal/ileocaecal surgery) vs non-colonic resections (ileal or ileocaecal resections and/or small-bowel strictureplasties without colectomy), with particular emphasis on intra-abdominal septic complications (intra-abdominal septic complications), non-intra-abdominal septic complications events, and length of stay (LOS) in hospital.
Were divided into two groups according to the index operation.
48.9% of colonic-resection patients had complications versus 33.2% after non-colonic resection
The median LOS was 11 days overall, with a statistically significant difference between the groups (Group A: 12 days; Group B: 11 days, p = 0.012).
In addition, we observed a significantly higher 30-day reoperation rate in Group A compared with Group B (14.4% vs 6.5%; p = 0.012).
Thirty-day readmission rates were low and did not differ significantly between the groups (3.3% vs 1.3%, p = 0.365).
There were no significant differences in the 30-day readmission rates among the groups, and no 30-day mortality cases were observed.
In this large single-centre cohort, colonic resections were associated with higher postoperative complication rates, increased intra-abdominal septic complications and longer LOS compared with non-colonic resections.
These differences likely reflect greater baseline disease complexity and operative burden in patients requiring colonic resection, rather than a causal effect of the resection site alone, highlighting the need for individualised, phenotype-informed surgical decision-making.