B. Sherman2, A. Harzman1, A. Traugott1, S. Husain1 1Ohio State University,Division Of Colon And Rectal Surgery,Columbus, OH, USA 2Ohio Health,Doctor’s Hospital,Columbus, OH, USA
Introduction: Due to chronic, recurrent nature of Crohn’s disease, many patients undergo repeat operations. These “redo” surgeries can be technically difficult due to the presence of adhesive disease and inflammatory / fibrotic changes. Thus, subsequent operative interventions are commonly perceived to be wrought with worse outcomes. While there is a plethora of literature on outcomes after index operations for Crohn’s disease, there is a scarcity of articles describing outcomes of redo operations and how they compare with index operations. An in-depth knowledge of these variables is critical for managing patient expectations and optimal perioperative planning from the surgeon’s perspective.
Methods: All Crohn’s patients undergoing surgery with the two participating surgeons over a period of six years were included. A retrospective chart review was conducted including patient demographics, comorbidities, postoperative complications, operative time, length of stay, and estimated blood loss. A comparison of in index versus redo operations was performed utilizing t-test for continuous variables and Fisher's exact test for categorical variables.
Results: We identified a total of 118 patients during the approved study period. Out of these 66 (55%) underwent index operation and 52 (45%) were redo operations. Overall complication rate was 29.66% (n=35), mean operative time was 220 minutes, average length of hospital stay was 8.36 days and EBL was 189.62 ml. There was no statistically significant difference between index and redo operations in terms of complication rates (27.27% vs 32.69%, p=0.55), EBL (211 vs 231 ml, p=0.85) and operative time (211 vs 231 min, p=0.28). However, the difference in length of stay between index operations (mean=6.79 days) and redo surgeries (mean=10.93 days) was statistically significant (p=0.0005). Laparoscopic approach was utilized at a significantly higher rate for index operations (61/66, 92.42%) compared to redo operations (35/52, 67.30%, p=0.007). Conversion rates were much higher for redo operations (3/35, 8.57%) than index operations (3/61, 4.91%). Use of laparoscopic approach narrowed the gap in length of stay between the index and redo groups from 4.14 days for the entire group to 1.8 days in patients who were treated laparoscopically.
Conclusion: Contrary to common perception, repeat operations in Crohn’s disease have similar outcomes as index operations however redo surgeries are associated with a much longer length of stay compared to initial surgeries. Utilization of laparoscopic technique reduces the gap in length of stay between index and redo operations however laparoscopy is associated with higher a conversion rate in redo operations.
