Techniques in Coloproctology

, Volume 22, Issue 12, pp 947–953 | Cite as

Risk of postoperative morbidity in patients having bowel resection for colonic Crohn’s disease

  • Igors IesalnieksEmail author
  • A. Spinelli
  • M. Frasson
  • F. Di Candido
  • B. Scheef
  • N. Horesh
  • M. Iborra
  • H. J. Schlitt
  • A. El-Hussuna
Original Article



The aim of the present multicenter study was to analyze the incidence and risk factors associated with postoperative morbidity in patients who had colorectal resection for colonic Crohn’s disease.


Consecutive patients undergoing colorectal resection for colonic Crohn’s disease at seven surgical units in 1992–2017 were included. Exclusion criteria were: proctectomy for perianal disease, surgery for cancer, previous colectomies, surgery before 1998. Abdominal colectomy and proctocolectomy were defined as extended resections; all other operations were classified as segmental resections. Postoperative intraabdominal septic complications (IASC) were: anastomotic leaks, peritonitis and abscess.


One hundred ninety-nine patients met the inclusion criteria: 116 patients had segmental resections and extended resections were performed in 83 patients. An anastomosis was constructed in 122 patients and an additional stoma was formed in 15 of those cases. Segmental resections were performed significantly more frequently in stricturing or penetrating disease (93% vs. 61%, p < 0.001) and were completed by an anastomosis more often than extended resections (78% vs. 37%, p < 0.001). The overall IASC rate was 17%. On multivariate analysis, formation of an anastomosis (Hazard ratio 2.9; 95% CI 1.1–7.7; p = 0.036) and preoperative hemoglobin level of < 10 g/dl (Hazard ratio 3.1; 95% CI 1.1–9.1; p = 0.034) were associated with an increase of postoperative IASC rate. Preoperative medication did not influence postoperative outcome.


Severe preoperative anemia is associated with an increased postoperative morbidity. Resections completed by an anastomosis pose an increased postoperative complication risk in patients with colonic Crohn’s disease as compared to resections without an anastomosis.


Crohn’s disease Surgery Colonic disease, postoperative morbidity 



No specific funding has been received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of retrospective cohort study, an informed consent is not required.


  1. 1.
    El-Hussuna A, Theede K, Olaison G (2014) Increased risk of post-operative complications in patients with Crohn’s disease treated with anti-tumour necrosis factor α agents—a systematic review. Dan Med J 61:A4975PubMedGoogle Scholar
  2. 2.
    Iesalnieks I, Kilger A, Glass H, Müller-Wille R, Klebl F, Ott C, Strauch U, Piso P, Schlitt HJ, Agha A (2008) Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome. Int J Colorectal Dis 23:1167–1174CrossRefGoogle Scholar
  3. 3.
    Wang H, Zuo L, Zhao J, Dong J, Li Y, Gu L, Gong J, Liu Q, Zhu W (2016) Impact of preoperative exclusive enteral nutrition on postoperative complications and recurrence after bowel resection in patients with active Crohn’s disease. World J Surg 40:1993–2000CrossRefGoogle Scholar
  4. 4.
    Billioud V, Ford AC, Tedesco ED, Colombel JF, Roblin X, Peyrin-Biroulet L (2013) Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohns Colitis 7:853–867CrossRefGoogle Scholar
  5. 5.
    Myrelid P, Olaison G, Sjödahl R, Nyström PO, Almer S, Andersson P (2009) Thiopurine therapy is associated with postoperative intra-abdominal septic complications in abdominal surgery for Crohn’s disease. Dis Colon Rectum 52:1387–1394CrossRefGoogle Scholar
  6. 6.
    Brouquet A, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y, GETAID chirurgie group (2018) Anti-TNF therapy is associated with an increased risk of postoperative morbidity after surgery for ileocolonic Crohn disease: results of a prospective nationwide cohort. Ann Surg 267:221–228CrossRefGoogle Scholar
  7. 7.
    Valizadeh N, Murray ACA, Suradkar K, Al-Mazrou A, Kiran RP (2017) Impact of preoperative steroid or immunosuppressant use on short-term outcomes following colectomy in Crohn’s disease patients. Tech Coloproctol 21:217–223. CrossRefPubMedGoogle Scholar
  8. 8.
    Jones DW, Finlayson SR (2010) Trends in surgery for Crohn’s disease in the era of infliximab. Ann Surg 252:307–312CrossRefGoogle Scholar
  9. 9.
    Handler M, Dotan I, Klausner JM, Yanai H, Neeman E, Tulchinsky H (2016) Clinical recurrence and re-resection rates after extensive vs. segmental colectomy in Crohn’s colitis: a retrospective cohort study. Tech Coloproctol 20:287–292CrossRefGoogle Scholar
  10. 10.
    Abdelaal K, Jaffray B (2016) Colonic disease site and perioperative complications predict need for later intestinal interventions following intestinal resection in pediatric Crohn’s disease. J Pediatr Surg 51:272–276CrossRefGoogle Scholar
  11. 11.
    Prabhakar LP, Laramee C, Nelson H, Dozois RR (1997) Avoiding a stoma: role for segmental or abdominal colectomy in Crohn’s colitis. Dis Colon Rectum 40:71–78CrossRefGoogle Scholar
  12. 12.
    Fichera A, McCormack R, Rubin MA, Hurst RD, Michelassi F (2005) Long-term outcome of surgically treated Crohn’s colitis: a prospective study. Dis Colon Rectum 48:963–969CrossRefGoogle Scholar
  13. 13.
    Martel P, Betton PO, Gallot D, Malafosse M (2002) Crohn’s colitis: experience with segmental resections; results in a series of 84 patients. J Am Coll Surg 194:448–453CrossRefGoogle Scholar
  14. 14.
    Li Y, Stocchi L, Mu X, Cherla D, Remzi FH (2016) Long-term outcomes of sphincter-saving procedures for diffuse Crohn’s disease of the large bowel. Dis Colon Rectum 59:1183–1190CrossRefGoogle Scholar
  15. 15.
    Sanfey H, Bayless TM, Cameron JL (1984) Crohn’s disease of the colon. Is there a role for limited resection? Am J Surg 147:38–42CrossRefGoogle Scholar
  16. 16.
    Andersson P, Olaison G, Hallböök O, Sjödahl R (2002) Segmental resection or subtotal colectomy in Crohn’s colitis? Dis Colon Rectum 45:47–53CrossRefGoogle Scholar
  17. 17.
    Allan A, Andrews H, Hilton CJ, Keighley MR, Allan RN, Alexander-Williams J (1989) Segmental colonic resection is an appropriate operation for short skip lesions due to Crohn’s disease in the colon. World J Surg 13:611–614CrossRefGoogle Scholar
  18. 18.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55:749–753CrossRefGoogle Scholar
  19. 19.
    Angriman I, Pirozzolo G, Bardini R, Cavallin F, Castoro C, Scarpa M (2017) A systematic review of segmental vs subtotal colectomy and subtotal colectomy vs total proctocolectomy for colonic Crohn’s disease. Colorectal Dis. CrossRefPubMedGoogle Scholar
  20. 20.
    Spinelli A, Allocca M, Jovani M, Danese S (2014) Review article: optimal preparation for surgery in Crohn’s disease. Aliment Pharmacol Ther 40:1009–1022CrossRefGoogle Scholar
  21. 21.
    Michailidou M, Nfonsam VN (2018) Preoperative anemia and outcomes in patients undergoing surgery for inflammatory bowel disease. Am J Surg 215:78–81CrossRefGoogle Scholar
  22. 22.
    Greenstein AJ, Kark AE, Dreiling DA (1975) Crohn’s disease of the colon. II. Controversial aspects of hemorrhage, anemia and rectal involvement in granulomatous disease involving the colon. Am J Gastroenterol 63:40–48PubMedGoogle Scholar
  23. 23.
    Bhagya Rao B, Koutroubakis IE, Rivers CR, Regueiro M, Swoger J, Schwartz M, Baidoo L, Hashash J, Barrie A, Dunn MA, Binion DG (2016) Correlation of anemia status with worsening bowel damage as measured by Lémann Index in patients with Crohn’s disease. Dig Liver Dis 48:626–631CrossRefGoogle Scholar
  24. 24.
    Rieder F, Paul G, Schnoy E, Schleder S, Wolf A, Kamm F, Dirmeier A, Strauch U, Obermeier F, Lopez R, Achkar JP, Rogler G, Klebl F (2014) Hemoglobin and hematocrit levels in the prediction of complicated Crohn’s disease behavior—a cohort study. PLoS One 9:e104706CrossRefGoogle Scholar
  25. 25.
    Bruewer M, Utech M, Rijcken EJ, Anthoni C, Laukoetter MG, Kersting S, Senninger N, Krieglstein CF (2003) Preoperative steroid administration: effect on morbidity among patients undergoing intestinal bowel resection for Crohn’s disease. World J Surg 27:1306–1310CrossRefGoogle Scholar
  26. 26.
    Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P (2007) Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 50:331–336CrossRefGoogle Scholar
  27. 27.
    Bolshinsky V, Li MH, Ismail H, Burbury K, Riedel B, Heriot A (2018) Multimodal prehabilitation programs as a bundle of care in gastrointestinal cancer surgery: a systematic review. Dis Colon Rectum 61:124–138CrossRefGoogle Scholar
  28. 28.
    Yamamoto T, Allan RN, Keighley MR (2000) Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum 43:1141–1145CrossRefGoogle Scholar
  29. 29.
    Qin G, Tu J, Liu L, Luo L, Wu J, Tao L, Zhang C, Geng X, Chen X, Ai X, Shen B, Pan W (2016) Serum albumin and C-reactive protein/albumin ratio are useful biomarkers of Crohn’s disease activity. Med Sci Monit 22:4393–4400CrossRefGoogle Scholar
  30. 30.
    Bamba S, Tsujikawa T, Ban H, Imaeda H, Inatomi O, Nishida A, Sasaki M, Andoh A, Fujiyama Y (2014) Predicting mucosal healing in Crohn’s disease using practical clinical indices with regard to the location of active disease. Hepatogastroenterology 61:689–696PubMedGoogle Scholar
  31. 31.
    Holubar SD, Holder-Murray J, Flasar M, Lazarev M (2015) Anti-tumor Necrosis factor-α antibody therapy management before and after intestinal surgery for inflammatory bowel disease: a CCFA position paper. Inflamm Bowel Dis 21:2658–2672CrossRefGoogle Scholar
  32. 32.
    Preiß JC, Bokemeyer B, Buhr HJ, Dignaß A, Häuser W, Hartmann F, Herrlinger KR, Kaltz B, Kienle P, Kruis W, Kucharzik T, Langhorst J, Schreiber S, Siegmund B, Stallmach A, Stange EF, Stein J, Hoffmann JC, German Society of Gastroenterology (2014) Updated German clinical practice guideline on “Diagnosis and treatment of Crohn’s disease”. Z Gastroenterol 52:1431–1484CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Igors Iesalnieks
    • 1
    • 2
    • 3
    Email author
  • A. Spinelli
    • 4
    • 5
  • M. Frasson
    • 6
  • F. Di Candido
    • 4
  • B. Scheef
    • 7
  • N. Horesh
    • 8
  • M. Iborra
    • 9
  • H. J. Schlitt
    • 1
  • A. El-Hussuna
    • 7
  1. 1.Department of SurgeryUniversity Clinic of RegensburgRegensburgGermany
  2. 2.Department of SurgeryMarienhospital GelsenkirchenGelsenkirchenGermany
  3. 3.Department of SurgeryMünchen Klinik BogenhausenMunichGermany
  4. 4.Division of Colon and Rectal SurgeryHumanitas Clinical and Research CenterMilanItaly
  5. 5.Department of Biomedical ScienceHumanitas UniversityMilanItaly
  6. 6.Department of General Surgery, Colorectal UnitLa Fe University and Polytechnic HospitalValenciaSpain
  7. 7.Department of SurgeryÅlborg University HospitalÅlborgDenmark
  8. 8.Department of Surgery and TransplantationChaim Sheba Medical Center (affiliated with the Faculty of Medicine, Tel Aviv University)Ramat GanIsrael
  9. 9.Department of Gastroenterology, IBD UnitLa Fe University and Polytechnic HospitalValenciaSpain

Personalised recommendations