Skip to main content
PMC home page
Gut logoLink to Gut
. 1998 Nov;43(5):634–638. doi: 10.1136/gut.43.5.634

Postoperative outcome of Crohn's disease in 30 children

M Besnard 1, O Jaby 1, J Mougenot 1, L Ferkdadji 1, A Debrun 1, C Faure 1, P Delagausie 1, M Peuchmaur 1, Y Aigrain 1, J Navarro 1, J Cezard 1
PMCID: PMC1727321  PMID: 9824343

Abstract

Background—Thirty children operated on for Crohn's disease (CD) were reviewed (1975-1994). The aim of the study was to assess their postoperative outcome. 
Patients—19 boys and 11 girls, aged 15.3 (2) years (range 11.3-20) at surgery were studied. 
Results—Surgical indications were acute complications of CD and chronic intestinal illness. Six months after surgery, 11 of 12 patients had been weaned off steroids, and 22 of 23 patients were weaned off nutritional support; 17 patients without recurrrence had a mean (SD) weight gain of 2.1 (8) kg and a height gain of 3.36 (3) cm. During 3.1 (2.7) years follow up, 12 patients (40%) had a recurrence of the disease after 19.4 (14) months (means (SD)): supra-anastomotic recurrence (six), severe perianal disease (two), and chronic illness (four). Six of 14 patients who were treated with mesalazine (13) or azathioprine (one) had recurrences. The postoperative recurrence rate was 50% at two years. 
Conclusion—Surgical treatment modifies the immediate outcome of severe or complicated CD, but does not prevent recurrence, despite localised resection or prophylactic postoperative treatment. Extension of the disease before surgery seems to be a major risk factor for postoperative recurrence in children. 



Keywords: Crohn's disease; surgery; children

Full Text

The Full Text of this article is available as a PDF (102.3 KB).

Figure 1 .

Figure 1

Open in a new tab

Postoperative treatment and recurrence of Crohn's disease. 


Selected References

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

  1. Alperstein G., Daum F., Fisher S. E., Aiges H., Markowitz J., Becker J., So H., Schwartz D., Silverberg M., Schneider K. Linear growth following surgery in children and adolescents with Crohn's disease: relationship to pubertal status. J Pediatr Surg. 1985 Apr;20(2):129–133. doi: 10.1016/s0022-3468(85)80284-0. [DOI] [PubMed] [Google Scholar]
  2. Brignola C., Cottone M., Pera A., Ardizzone S., Scribano M. L., De Franchis R., D'Arienzo A., D'Albasio G., Pennestri D. Mesalamine in the prevention of endoscopic recurrence after intestinal resection for Crohn's disease. Italian Cooperative Study Group. Gastroenterology. 1995 Feb;108(2):345–349. doi: 10.1016/0016-5085(95)90059-4. [DOI] [PubMed] [Google Scholar]
  3. Cameron J. L., Hamilton S. R., Coleman J., Sitzmann J. V., Bayless T. M. Patterns of ileal recurrence in Crohn's disease. A prospective randomized study. Ann Surg. 1992 May;215(5):546–552. doi: 10.1097/00000658-199205000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Caprilli R., Andreoli A., Capurso L., Corrao G., D'Albasio G., Gioieni A., Assuero Lanfranchi G., Paladini I., Pallone F., Ponti V. Oral mesalazine (5-aminosalicylic acid; Asacol) for the prevention of post-operative recurrence of Crohn's disease. Gruppo Italiano per lo Studio del Colon e del Retto (GISC). Aliment Pharmacol Ther. 1994 Feb;8(1):35–43. doi: 10.1111/j.1365-2036.1994.tb00158.x. [DOI] [PubMed] [Google Scholar]
  5. Castile R. G., Telander R. L., Cooney D. R., Ilstrup D. M., Perrault J., van Heerden J., Stickler G. B. Crohn's disease in children: assessment of the progression of disease, growth, and prognosis. J Pediatr Surg. 1980 Aug;15(4):462–469. doi: 10.1016/s0022-3468(80)80754-8. [DOI] [PubMed] [Google Scholar]
  6. Coran A. G., Klein M. D., Sarahan T. M. The surgical management of terminal ileal and right colon Crohn's disease in children. J Pediatr Surg. 1983 Oct;18(5):592–594. doi: 10.1016/s0022-3468(83)80367-4. [DOI] [PubMed] [Google Scholar]
  7. Davies G., Evans C. M., Shand W. S., Walker-Smith J. A. Surgery for Crohn's disease in childhood: influence of site of disease and operative procedure on outcome. Br J Surg. 1990 Aug;77(8):891–894. doi: 10.1002/bjs.1800770816. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. DiCandio G., Mosca F., Campatelli A., Bianchini M., D'Elia F., Dellagiovampaola C. Sonographic detection of postsurgical recurrence of Crohn disease. AJR Am J Roentgenol. 1986 Mar;146(3):523–526. doi: 10.2214/ajr.146.3.523. [DOI] [PubMed] [Google Scholar]
  10. Evans C. M., Kirk J. M., Savage M. O., Walker-Smith J. A. Growth after gut resection for Crohn's disease. Arch Dis Child. 1991 Mar;66(3):370–370. doi: 10.1136/adc.66.3.370. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ewe K., Herfarth C., Malchow H., Jesdinsky H. J. Postoperative recurrence of Crohn's disease in relation to radicality of operation and sulfasalazine prophylaxis: a multicenter trial. Digestion. 1989;42(4):224–232. doi: 10.1159/000199850. [DOI] [PubMed] [Google Scholar]
  12. Farmer R. G., Whelan G., Fazio V. W. Long-term follow-up of patients with Crohn's disease. Relationship between the clinical pattern and prognosis. Gastroenterology. 1985 Jun;88(6):1818–1825. doi: 10.1016/0016-5085(85)90006-x. [DOI] [PubMed] [Google Scholar]
  13. Fasth S., Hellberg R., Hultén L., Ahrén C. Site of recurrence, extent of ileal disease and magnitude of resection in primary and recurrent Crohn's disease. Acta Chir Scand. 1981;147(7):569–576. [PubMed] [Google Scholar]
  14. Goligher J. C. The long-term results of excisional surgery for primary and recurrent Crohn's disease of the large intestine. Dis Colon Rectum. 1985 Jan;28(1):51–55. doi: 10.1007/BF02553908. [DOI] [PubMed] [Google Scholar]
  15. Greenstein A. J., Lachman P., Sachar D. B., Springhorn J., Heimann T., Janowitz H. D., Aufses A. H., Jr Perforating and non-perforating indications for repeated operations in Crohn's disease: evidence for two clinical forms. Gut. 1988 May;29(5):588–592. doi: 10.1136/gut.29.5.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Greenstein A. J., Sachar D. B., Pasternack B. S., Janowitz H. D. Reoperation and recurrence in Crohn's colitis and ileocolitis Crude and cumulative rates. N Engl J Med. 1975 Oct 2;293(14):685–690. doi: 10.1056/NEJM197510022931403. [DOI] [PubMed] [Google Scholar]
  17. Griffiths A. M., Wesson D. E., Shandling B., Corey M., Sherman P. M. Factors influencing postoperative recurrence of Crohn's disease in childhood. Gut. 1991 May;32(5):491–495. doi: 10.1136/gut.32.5.491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Gryboski J. D., Spiro H. M. Prognosis in children with Crohn's disease. Gastroenterology. 1978 May;74(5 Pt 1):807–817. [PubMed] [Google Scholar]
  19. Hamilton S. R., Reese J., Pennington L., Boitnott J. K., Bayless T. M., Cameron J. L. The role of resection margin frozen section in the surgical management of Crohn's disease. Surg Gynecol Obstet. 1985 Jan;160(1):57–62. [PubMed] [Google Scholar]
  20. Hellberg R., Hultén L., Rosengren C., Ahrén C. The recurrence rate after primary excisional surgery for Crohn's disease. Acta Chir Scand. 1980;146(6):435–443. [PubMed] [Google Scholar]
  21. Higgens C. S., Allan R. N. Crohn's disease of the distal ileum. Gut. 1980 Nov;21(11):933–940. doi: 10.1136/gut.21.11.933. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Homer D. R., Grand R. J., Colodny A. H. Growth, course, and prognosis after surgery for Crohn's disease in children and adolescents. Pediatrics. 1977 May;59(5):717–725. [PubMed] [Google Scholar]
  23. Hultén L. Surgical management and strategy in classical Crohn's disease. Int Surg. 1992 Jan-Mar;77(1):2–8. [PubMed] [Google Scholar]
  24. Lee E. C., Papaioannou N. Recurrences following surgery for Crohn's disease. Clin Gastroenterol. 1980 May;9(2):419–438. [PubMed] [Google Scholar]
  25. Lock M. R., Fazio V. W., Farmer R. G., Jagelman D. G., Lavery I. C., Weakley F. L. Proximal recurrence and the fate of the rectum following excisional surgery for Crohn's disease of the large bowel. Ann Surg. 1981 Dec;194(6):754–760. doi: 10.1097/00000658-198112000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Longo W. E., Oakley J. R., Lavery I. C., Church J. M., Fazio V. W. Outcome of ileorectal anastomosis for Crohn's colitis. Dis Colon Rectum. 1992 Nov;35(11):1066–1071. doi: 10.1007/BF02252997. [DOI] [PubMed] [Google Scholar]
  27. Meyers S., Walfish J. S., Sachar D. B., Greenstein A. J., Hill A. G., Janowitz H. D. Quality of life after surgery for Crohn's disease: a psychosocial survey. Gastroenterology. 1980 Jan;78(1):1–6. [PubMed] [Google Scholar]
  28. Michelassi F., Balestracci T., Chappell R., Block G. E. Primary and recurrent Crohn's disease. Experience with 1379 patients. Ann Surg. 1991 Sep;214(3):230–240. doi: 10.1097/00000658-199109000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Olaison G., Smedh K., Sjödahl R. Natural course of Crohn's disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut. 1992 Mar;33(3):331–335. doi: 10.1136/gut.33.3.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Oliva L., Wyllie R., Alexander F., Caulfield M., Steffen R., Lavery I., Fazio V. The results of strictureplasty in pediatric patients with multifocal Crohn's disease. J Pediatr Gastroenterol Nutr. 1994 Apr;18(3):306–310. doi: 10.1097/00005176-199404000-00009. [DOI] [PubMed] [Google Scholar]
  31. Puntis J., McNeish A. S., Allan R. N. Long term prognosis of Crohn's disease with onset in childhood and adolescence. Gut. 1984 Apr;25(4):329–336. doi: 10.1136/gut.25.4.329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Rabbett H., Elbadri A., Thwaites R., Northover H., Dady I., Firth D., Hillier V. F., Miller V., Thomas A. G. Quality of life in children with Crohn's disease. J Pediatr Gastroenterol Nutr. 1996 Dec;23(5):528–533. doi: 10.1097/00005176-199612000-00003. [DOI] [PubMed] [Google Scholar]
  33. Rutgeerts P., Geboes K. Crohn's disease and pre-aphthoid lesions. Lancet. 1993 Jun 5;341(8858):1443–1444. doi: 10.1016/0140-6736(93)90886-l. [DOI] [PubMed] [Google Scholar]
  34. Rutgeerts P., Geboes K., Vantrappen G., Beyls J., Kerremans R., Hiele M. Predictability of the postoperative course of Crohn's disease. Gastroenterology. 1990 Oct;99(4):956–963. doi: 10.1016/0016-5085(90)90613-6. [DOI] [PubMed] [Google Scholar]
  35. Rutgeerts P., Geboes K., Vantrappen G., Kerremans R., Coenegrachts J. L., Coremans G. Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. Gut. 1984 Jun;25(6):665–672. doi: 10.1136/gut.25.6.665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Rutgeerts P., Goboes K., Peeters M., Hiele M., Penninckx F., Aerts R., Kerremans R., Vantrappen G. Effect of faecal stream diversion on recurrence of Crohn's disease in the neoterminal ileum. Lancet. 1991 Sep 28;338(8770):771–774. doi: 10.1016/0140-6736(91)90663-a. [DOI] [PubMed] [Google Scholar]
  37. Rutgeerts P., Hiele M., Geboes K., Peeters M., Penninckx F., Aerts R., Kerremans R. Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection. Gastroenterology. 1995 Jun;108(6):1617–1621. doi: 10.1016/0016-5085(95)90121-3. [DOI] [PubMed] [Google Scholar]
  38. Sachar D. B., Wolfson D. M., Greenstein A. J., Goldberg J., Styczynski R., Janowitz H. D. Risk factors for postoperative recurrence of Crohn's disease. Gastroenterology. 1983 Oct;85(4):917–921. [PubMed] [Google Scholar]
  39. Sankey E. A., Dhillon A. P., Anthony A., Wakefield A. J., Sim R., More L., Hudson M., Sawyerr A. M., Pounder R. E. Early mucosal changes in Crohn's disease. Gut. 1993 Mar;34(3):375–381. doi: 10.1136/gut.34.3.375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Scott N. A., Hughes L. E. Timing of ileocolonic resection for symptomatic Crohn's disease--the patient's view. Gut. 1994 May;35(5):656–657. doi: 10.1136/gut.35.5.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Sedgwick D. M., Barton J. R., Hamer-Hodges D. W., Nixon S. J., Ferguson A. Population-based study of surgery in juvenile onset Crohn's disease. Br J Surg. 1991 Feb;78(2):171–175. doi: 10.1002/bjs.1800780212. [DOI] [PubMed] [Google Scholar]
  42. Telander R. L., Spencer M., Perrault J., Telander D., Zinsmeister A. R. Long-term follow-up of the ileoanal anastomosis in children and young adults. Surgery. 1990 Oct;108(4):717–725. [PubMed] [Google Scholar]
  43. Wenckert A., Kristensen M., Eklund A. E., Barany F., Jarnum S., Worning H., Folkenborg O., Holtz A., Bonnevie O., Riis P. The long-term prophylactic effect of salazosulphapyridine (Salazopyrin) in primarily resected patients with Crohn's disease. A controlled double-blind trial. Scand J Gastroenterol. 1978;13(2):161–167. doi: 10.3109/00365527809181743. [DOI] [PubMed] [Google Scholar]
  44. Wesson D. E., Shandling B. Results of bowel resection for Crohn's disease in the young. J Pediatr Surg. 1981 Aug;16(4):449–452. doi: 10.1016/s0022-3468(81)80004-8. [DOI] [PubMed] [Google Scholar]
  45. Williams J. G., Wong W. D., Rothenberger D. A., Goldberg S. M. Recurrence of Crohn's disease after resection. Br J Surg. 1991 Jan;78(1):10–19. doi: 10.1002/bjs.1800780106. [DOI] [PubMed] [Google Scholar]
  46. Winslet M. C., Andrews H., Allan R. N., Keighley M. R. Fecal diversion in the management of Crohn's disease of the colon. Dis Colon Rectum. 1993 Aug;36(8):757–762. doi: 10.1007/BF02048367. [DOI] [PubMed] [Google Scholar]
  47. Wolff B. G., Beart R. W., Jr, Frydenberg H. B., Weiland L. H., Agrez M. V., Ilstrup D. M. The importance of disease-free margins in resections for Crohn's disease. Dis Colon Rectum. 1983 Apr;26(4):239–243. doi: 10.1007/BF02562486. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES