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. 1978 May;187(5):530–535. doi: 10.1097/00000658-197805000-00011

Comparison of the results of resection, bypass, and bypass with exclusion for ileocecal Crohn's disease.

W P Homan, P Dineen
PMCID: PMC1396558  PMID: 646491

Abstract

Controversy continues regarding the optimal surgical treatment of Crohn's disease involving the ileum and cecum. Over 43-years, 161 patients underwent primary surgery for this disease at The New York Hospital-Cornell Medical Center. Resection was performed in 115 patients, bypass with exclusion in 25, and side-to-side ileotranverse colostomy in 21. Overall recurrence rates were 25% for resection, 63% for bypass with exclusion, and 75% for simple bypass. Expressed as 15 year follow-up, recurrence rate were 65% for resection, 82% for bypass with exclusion, and 94% for simple bypass. Much of the difference in final outcome was accounted for by early recurrence or by persistent disease in the two bypass groups. This amounted to 21% for the bypass with exclusion and 45% for simple bypass as compared to 3% for patients who had resection. Conclusions from this review are that 1) resection can be performed with a morbidity and mortality equivalent to either of the bypass procedures; 2) the recurrence rat following resection is significantly lower than bypass with exclusion or simple bypass, and amounts to about 4% per year; 3) continuing disease in the bypassed loop accounts for a high percentage of reoperations in the bypass groups, while appearance of new disease is the usual problem following resection; 4) resection is the surgical treatment of choice for ileocecal Crohn's disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alavi I. A., Printen K., Steigmann F. Free perforation in chronic regional enteritis. Am J Dig Dis. 1969 Jun;14(6):420–423. doi: 10.1007/BF02239362. [DOI] [PubMed] [Google Scholar]
  2. Alexander-Williams J., Fielding J. F., Cooke W. T. A comparison of results of excision and bypass for ileal Crohn's disease. Gut. 1972 Dec;13(12):973–975. doi: 10.1136/gut.13.12.973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Atwell J. D., Duthie H. L., Goligher J. C. The outcome of Crohn's disease. Br J Surg. 1965 Dec;52(12):966–972. doi: 10.1002/bjs.1800521214. [DOI] [PubMed] [Google Scholar]
  4. BROWN C. H., DAFFNER J. E. Regional enteritis. II. Results of medical and surgical treatment in 100 patients. Ann Intern Med. 1958 Sep;49(3):595–606. doi: 10.7326/0003-4819-49-3-595. [DOI] [PubMed] [Google Scholar]
  5. Barber K. W., Waugh J. M., Beahrs O. H., Sauer W. G. Indications for and the Results of the Surgical Treatment of Regional Enteritis. Ann Surg. 1962 Sep;156(3):472–480. doi: 10.1097/00000658-196209000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Colcock B. P. Operative technique in surgery for Crohn's disease and its relationship to recurrence. Surg Clin North Am. 1973 Apr;53(2):375–380. doi: 10.1016/s0039-6109(16)39991-1. [DOI] [PubMed] [Google Scholar]
  7. De Dombal F. T., Burton I., Goligher J. C. Recurrence of Crohn's disease after primary excisional surgery. Gut. 1971 Jul;12(7):519–527. doi: 10.1136/gut.12.7.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. GARLOCK J. H., CROHN B. B., KLEIN S. H., YARNIS H. An appraisal of the long-term results of surgical treatment of regional ileitis. Gastroenterology. 1951 Nov;19(3):414–423. [PubMed] [Google Scholar]
  9. HEATON L. D., RAVDIN I. S., BLADES B., WHELAN T. J. PRESIDENT EISENHOWER'S OPERATION FOR REGIONAL ENTERITIS: A FOOTNOTE TO HISTORY. Ann Surg. 1964 May;159:661–666. doi: 10.1097/00000658-196405000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Koudahl G., Kristensen M., Lenz K. Bypass compared with resection for ileal Crohn's disease. Scand J Gastroenterol. 1974;9(2):203–206. [PubMed] [Google Scholar]
  11. Nesbit R. R., Jr, Elbadawi N. A., Morton J. H., Cooper R. A., Jr Carcinoma of the small bowel. A complication of regional enteritis. Cancer. 1976 Jun;37(6):2948–2959. doi: 10.1002/1097-0142(197606)37:6<2948::aid-cncr2820370652>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  12. SCHOFIELD P. F. THE NATURAL HISTORY AND TREATMENT OF CROHN'S DISEASE. Ann R Coll Surg Engl. 1965 May;36:258–279. [PMC free article] [PubMed] [Google Scholar]
  13. Waye J. D., Lithgow C. Small bowel perforation in regional enteritis. Gastroenterology. 1967 Oct;53(4):625–629. [PubMed] [Google Scholar]
  14. Williams J. A. The place of surgery in Crohn's disease. Gut. 1971 Sep;12(9):739–749. doi: 10.1136/gut.12.9.739. [DOI] [PMC free article] [PubMed] [Google Scholar]

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