Postoperative recurrence in Crohn's disease. The effect of the initial length of bowel resection and operative procedure.

We reviewed the surgical experience of 61 patients with Crohn's disease who have received surgical treatment over a 32-year period. Sex, age at onset of symptoms, associated systemic abnormalities, presenting symptoms, indication for previous surgery, and site of disease were not significant predictors of postoperative recurrence. Certain extensive resections of the small bowel are associated with a decreased probability of rehospitalization and reoperation. Resection of more than 25 cm of the small bowel and more than 50 cm of the "total" (small plus large) bowel was associated with a decreased likelihood of recurrence. Interestingly, analysis of larger resections (50, 75, 100 cm) failed to document a decreased likelihood of recurrence. The amount of large bowel resected did not predict postoperative recurrence. Bypass and diversion procedures offer a significantly enhanced risk for recurrent disease, whereas procedures employing resection are associated with lower probabilities of recurrent disease. We conclude that technically adequate resections of 25 to 50 cm of the small bowel or the combined small and large bowel are associated with a decreased probability of reoperation or rehospitalization after the initial surgery for Crohn's disease.