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Surgery for Crohn colitis over a twenty-eight-year period : fewer stomas and the replacement of total colectomy by segmental resection

Andersson, Peter, 1957- (author)
Linköpings universitet,Kirurgi,Hälsouniversitetet
Olaison, Gunnar, 1947- (author)
Linköpings universitet,Kirurgi,Hälsouniversitetet
Bodemar, Göran, 1941- (author)
Linköpings universitet,Gastroenterologi och hepatologi,Hälsouniversitetet
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Nyström, Per-Olof, 1947- (author)
Linköpings universitet,Kirurgi,Hälsouniversitetet
Sjödahl, Rune, 1938- (author)
Linköpings universitet,Kirurgi,Hälsouniversitetet
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 (creator_code:org_t)
2009-07-08
2002
English.
In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 37:1, s. 68-73
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Background: This study describes how surgery for Crohn colitis developed between 1970 and 1997, towards the end of which period limited resection and medical maintenance treatment was introduced.Methods: A cohort of 211 patients with Crohn colitis (115 population-based), of which 84 had a primary colonic resection (42 population-based), was investigated regarding indication for surgery, the time from diagnosis to operation, type of primary colonic resection, risk for permanent stoma and medication over four 7-year periods.Results: Comparison of the periods 1970-90 and 1991-97 revealed that active disease as an indication for surgery decreased from 64% to 25% ( P < 0.01) while stricture as an indication increased from 9% to 50% ( P < 0.001). Median time from diagnosis to operation increased from 3.5 to 11.5 years ( P < 0.01). Proctocolectomy or colectomy fell from 68.8% to 10% of the primary resections, whereas segmental resection increased from 31.2% to 90%. At the end of the first 7-year period, 26% had medical maintenance treatment, steroids or azathioprine taken by 7%. Corresponding figures for the last period were 70% and 49%. Patients diagnosed during the last two time-periods had less risk for surgery ( P = 0.017), permanent stoma ( P < 0.01) and total colectomy ( P < 0.01). Findings were similar in the population-based cohort.Conclusions: Current management of Crohn colitis implies a longer period between diagnosis and surgery, a reduced risk for surgery and permanent stoma, and the replacement of total colectomy by segmental resection.

Keyword

Colectomy
Colitis
Crohn Disease
Population-BASED
Stoma
Surgery
MEDICINE
MEDICIN

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art (subject category)

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