PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 co...PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 consecutive patients (32 males; mean age, 32 ± 9 years) who had undergone a first laparoscopic ileocecal resection for Crohn’ s disease were included in a prospective study. Twenty-one patients (30 percent) were converted into laparotomy. Possible factors for conversion were analyzed by both univariate and multivariate analyses. RESULTS: No patient died. Four patients (9 percent; 2 in each group) required five reoperations because of intraperitoneal hemorrhage (n = 1), anastomotic fistula (n = 3), and small bowel obstruction (n = 1). Mean hospital stay was significantly increased in converted compared with laparoscopic patients (9 ± 4 vs. 7 ± 3 days; P < 0.05). On univariate analysis, more than three episodes of acute flare of Crohn’ s disease (P = 0.02), male gender (P = 0.03), preoperative immunosuppressive drugs (P = 0.04), intra-abdominal abscess or fistula at the time of laparoscopy (P = 0.02), and resection of other intestinal segment (P = 0.02) were factors that predicted conversion. On multivariate analysis, recurrent medical episodes of Crohn’ s disease (odds ratio, 2; 95 percent confidence interval, 1-4), and intra-abdominal abscess or fistula at the time of laparoscopy (odds ratio, 15; 95 percent confidence interval, 4-78) were the two independent risk factors for conversion. CONCLUSIONS: This prospective study demonstrated that the severity of the disease increased significantly the conversion rate of the first laparoscopic ileocecal resection. Knowledge of these risk factors for conversion could be helpful in preoperative preparation and counseling of patients.展开更多
Objectives - Patients frequently ask questions about the lifetime prognosis of Crohn’ s disease. The aim of this study was to describe the outcomes of Cro hn’ s disease more than 20 years after diagnosis. Methods - ...Objectives - Patients frequently ask questions about the lifetime prognosis of Crohn’ s disease. The aim of this study was to describe the outcomes of Cro hn’ s disease more than 20 years after diagnosis. Methods - Data from all pat ients with Crohn’ s disease whose diagnosis had been performed before 1st Janua ry 1978 were analyzed. All referred patients filled in a medical and health- re lated quality- of- life questionnaire. Results - Among 273 patients with Cro hn’ s disease diagnosed more than 20 years ago, 141 (52% ) patients answered o ur questionnaire, 45 (16% ) patients were alive but did not wish to answer our questionnaire, 51 (19% ) could not be traced and 36 (13% ) died before July 19 98. At the end of follow- up, 25.7 (20.0- 59.3) years after diagnosis, 24% h ad a relapse in the previous 12 months, and 48% and 28% had quiescent diseas e with and without treatment, respectively. These ratios were not different from those observed three years after Crohn’ s disease diagnosis. Sixteen patients died within 20 years after CD diagnosis, including 11 from CD- related causes. The risk of death estimated by Kaplan- Meier life- tables analysis was non- s ignificantly higher if death was related to CD. An ileal or colic adenocarcinoma was noted in 6 (3.4% ) patients. Conclusions - Crohn’ s disease activity do es not burn out with time, and roughly one- quarter of the patients had active disease 20 years after diagnosis.展开更多
文摘PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 consecutive patients (32 males; mean age, 32 ± 9 years) who had undergone a first laparoscopic ileocecal resection for Crohn’ s disease were included in a prospective study. Twenty-one patients (30 percent) were converted into laparotomy. Possible factors for conversion were analyzed by both univariate and multivariate analyses. RESULTS: No patient died. Four patients (9 percent; 2 in each group) required five reoperations because of intraperitoneal hemorrhage (n = 1), anastomotic fistula (n = 3), and small bowel obstruction (n = 1). Mean hospital stay was significantly increased in converted compared with laparoscopic patients (9 ± 4 vs. 7 ± 3 days; P < 0.05). On univariate analysis, more than three episodes of acute flare of Crohn’ s disease (P = 0.02), male gender (P = 0.03), preoperative immunosuppressive drugs (P = 0.04), intra-abdominal abscess or fistula at the time of laparoscopy (P = 0.02), and resection of other intestinal segment (P = 0.02) were factors that predicted conversion. On multivariate analysis, recurrent medical episodes of Crohn’ s disease (odds ratio, 2; 95 percent confidence interval, 1-4), and intra-abdominal abscess or fistula at the time of laparoscopy (odds ratio, 15; 95 percent confidence interval, 4-78) were the two independent risk factors for conversion. CONCLUSIONS: This prospective study demonstrated that the severity of the disease increased significantly the conversion rate of the first laparoscopic ileocecal resection. Knowledge of these risk factors for conversion could be helpful in preoperative preparation and counseling of patients.
文摘Objectives - Patients frequently ask questions about the lifetime prognosis of Crohn’ s disease. The aim of this study was to describe the outcomes of Cro hn’ s disease more than 20 years after diagnosis. Methods - Data from all pat ients with Crohn’ s disease whose diagnosis had been performed before 1st Janua ry 1978 were analyzed. All referred patients filled in a medical and health- re lated quality- of- life questionnaire. Results - Among 273 patients with Cro hn’ s disease diagnosed more than 20 years ago, 141 (52% ) patients answered o ur questionnaire, 45 (16% ) patients were alive but did not wish to answer our questionnaire, 51 (19% ) could not be traced and 36 (13% ) died before July 19 98. At the end of follow- up, 25.7 (20.0- 59.3) years after diagnosis, 24% h ad a relapse in the previous 12 months, and 48% and 28% had quiescent diseas e with and without treatment, respectively. These ratios were not different from those observed three years after Crohn’ s disease diagnosis. Sixteen patients died within 20 years after CD diagnosis, including 11 from CD- related causes. The risk of death estimated by Kaplan- Meier life- tables analysis was non- s ignificantly higher if death was related to CD. An ileal or colic adenocarcinoma was noted in 6 (3.4% ) patients. Conclusions - Crohn’ s disease activity do es not burn out with time, and roughly one- quarter of the patients had active disease 20 years after diagnosis.
