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Acta Endoscopica

, Volume 33, Issue 2, pp 241–248 | Cite as

Place de la chirurgie dans le traitement de la maladie de Crohn

  • R. Detry
  • R. Fiasse
Article
  • 47 Downloads

Résumé

Les auteurs ont confronté leur expérience dans le traitement chirurgical de la maladie de Crohn de l'adulte avec les résultats de quelques grandes séries rapportés dans la littérature. Au cours de 25 ans, 533 opérations de résection intestinale ont été réalisées, incluant une opération initiale chez 348 patients (177 femmes, 171 hommes, âge médian: 33 ans, extrêmes: 18–80 ans), sans aucune mortalité. Les principales indications de la résection intestinale, limitée aux lésions macroscopiques, ont été les sténoses et fistules symptomatiques (respectivement 45,7% et 37%). Comme dans les autres séries rapportées la récidive définie comme une réopération a été fréquente avec un taux cumulatif de réopération de 11% après 5 ans, de 29% après 10 ans, de 41% après 15 ans et de 70% après 20 ans. Cependant, le taux cumulatif de réopération à 10 ans a été nul chez les patients aynnt subi une coloproctectomie totale avec iléostomie. Chez 18 patients, dont 8 avaient déjà subi une première opération, 68 stricturoplasties ont été réalisées, associées à une résection iléo-colique et/ou une résection grêle segmentaire chez 15. Après stricturoplastie, le taux de réopération a été de 33% pendant un suivi médian de 33,5 mois (8–144).

La confirmation du très haut risque de récidive après chirurgie conservatrice pour maladie de Crohn, qui ne peut être réduit jusqu'ici que par l'arrêt du tabac, souligne la nécessité de poursuivre des études randomisées sur la chimioprévention post-chirurgicale. Celle-ci, si elle est efficace et bien tolérée pourrait même permettre une chirurgie encore plus conservatrice, comme l'anastomose anale sur poche iléale chez les patients ayant gardé une bonne fonction sphinctérienne anale.

Mots-clés

azathioprine chirurgie maladie de Crohn stricturoplastie 

Role of surgery in the management of Crohn's disease

Summary

The authors compare their experience in the surgical treatment of Crohn's disease with the results from several large series in the literature. Over 25 years 533 intestinal operations in adults were performed, including a first operation in 348 patients (177 women, 171 men, median age: 33 years, range: 15–80 years), with no mortality. The main indications for intestinal resection limited to macroscopic disease were symptomatic strictures (45.7%) and fistulas (37%). As observed in other series reported, recurrences assessed as reoperations have been frequent, with a cumulative resection rate of 11% after 5 years, 29% after 10 years, 41% after 15 years and 70% after 20 years. However, 10-year cumulative reoperation rate was nil after coloproctectomy + ileostomy. In 18 patients, including 8 with previous surgery, 68 stricturoplasties were performed, associated with ileocolic and/or segmental jejuno-ileal resections in 15. After stricturoplasty, the reoperation rate was 33% over a median followup of 33.5 months (8–144).

The confirmation of the high risk of recurrence after conservative surgery for Crohn's disease, which can only be reduced by cessation of smoking urges the need to pursue randomized trials about post-surgical chemoprevention. If effective and safe, chemoprevention could allow even more conservative surgery, such as ileal-pouch anastomosis in patients with satisfactory anal sphincter function.

Key-words

azathioprine Crohn disease strictureplasty surgery 

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • R. Detry
    • 1
  • R. Fiasse
    • 1
  1. 1.Service de Chirurgie de l'Appareil digestifCliniques Saint-Luc UCLBruxelles(Belgique)

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