Surgery and Postoperative Recurrence in Children With Crohn's Disease - A Retrospective Study (1978-2007)

OBJECTIVES:: To describe surgery rates, complications and risk of disease recurrence after surgery in paediatric Crohn's disease (CD).

METHODS:: Children <18 years with a diagnosis of CD and a least one intestinal resection from the period 1.1.1978-31.12.2007 were identified using the Danish National Patient Registry. Patient charts were used to extract data.

RESULTS:: 115 of 422 CD children, who had surgery in two referral centers, were futher studied.Disease extension according to the Montreal classification at the time of operation was available in 106/115 patients: B1 39/106 (37%), B2 59/106 (56%) and B3 8/106 (7%).Before/after surgery 89%/36% of the patients received corticosteroids, 26%/61% azathioprine (AZA) and 15%/34% infliximab. Ileo-coecal resection was performed in 54 (47%), 17 (15%) underwent ileal resection, 21 (18%) colectomy, 13 (11%) hemi colectomy and 10 (9%) a combined colonic and ileal resection. Median time from diagnosis to surgery was 23 months (range 0-147).The median follow-up time after surgery was 121 months (16-226) and median time to disease recurrence was 12 months (3-160). The cumulative clinical recurrence rates at 1,5 and 10 years were 50%, 73% and 77% respectively. More than one bowel resection was needed in 39%.Postoperative AZA treatment did not affect rate of recurrence after surgery.

CONCLUSION:: In this large cohort of children with CD followed >10 years postoperatively we found a high postoperative recurrence rate of disease and a frequent need for more than one intestinal resection.