CD can affect any part of the GI tract, but the terminal ileum (TI) is the most common. The risk of surgery based on all population-based studies, at 1, 5, and 10 years after diagnosis of CD is 16.3%, 33.3% and 46.6% respectively. The risk of reoperation following a TI resection has been reported as 70% at 20 years based on a population of 1379 patients. A recent study comparing laparoscopic ileal resection versus infliximab found that laparoscopic ileocaecal resection results in similar quality-of-life scores and is not associated with more serious adverse. The long-term outcomes of those undergoing ileal resection have yet to be studied and may help identify risk factors for those that may require further operations.Methods
The Hospital Episodes Statistics (HES) dataset was used to identify all patients admitted to hospitals in England from 1997–2012. Time trends and multivariate logistic regression analysis was undertaken to determine factors associated with repeated resection.Results
1 55 236 patients were identified as having CD with a median follow-up was 92 months (IQR 43–143). Of these, 18.8% (29,257) underwent TI resection. Amongst this sub-group, 11.0% (n=3,101/29,257) required more than one resection. The total number of procedures performed was 32,889, of which 56.6% (n=18,622/32,889) were right hemicolectomy/ileo-caecal resection. The median time between resections was 41 months (IQR 15–74 months). There was no significant change in the number of procedures performed each year (p=0.693). Of the total population, 7.8% (n=12,173/155,236) had Infliximab therapy.Conclusions
Nearly one in five patients will require surgical intervention over a 15 year period for CD, of those undergoing TI resection only 11% of these will require further surgery. This is the largest population-based study reporting the requirement for further surgery following TI resection and suggests that the reoperation rate is far lower than previously reported. The number of procedures performed has largely remained the same over time suggesting that medical therapy has not altered the overall rates of further surgery following TI surgery in CD.