A comparison of results of excision and bypass for ileal Crohn's disease.

One hundred and ten patients presented with Crohn's disease confined to the terminal ileum, and indications for their surgical treatment are reviewed. Treatment was either by ileo-transverse side-to-side bypass (21 patients) or primary excision and end-to-end ileo-colic anastomosis (89 patients). In a long follow up (mean 13.8 years) the date and indications for the second major operative intervention are recorded. The cumulative risk of recurrence recorded each year after the primary operation shows that after bypass compared with excision there is approximately twice the risk of requiring a further major operation. After bypass the indication for the second operation is usually a local complication of the still active disease and after excision it is usually a juxta-anastomotic recurrence with stenosis.