Background: Approximately 40% of patients affected by Crohn's Disease (CD) require surgical treatment in their lifetime. An adequate pre-operative management including improvement of nutritional status may decrease the complication rate. An enteral polymeric diet (EPD) enriched with transforming growth factor-beta2 has been shown to be useful in patients with CD, and able to induce remission in pediatric patients. No data is still available about patients with CD scheduled for surgery.
The aim of the study was to assess the efficacy of EPD as nutritional support to standard of care diet (SCD) in CD patients undergoing surgery.
Methods: We evaluated patients with ileal CD referred to our center and treated with laparoscopic ileo-cecal resection throughout 12 months; we excluded patients with colonic resection in order to have a more homogeneous sample. Medical treatment, Body Mass Index (BMI), serum albumin and hemoglobin were assessed in all patients the day before the surgical procedure.
We evaluated the operative and postoperative course (conversion to laparotomy, need for surgical re-treatment in the following three months, days of stay in hospital). We considered as a worse outcome the conversion, the surgical re-treatment, and a stay in hospital exceeding 7 days after surgery.
According to nutritional therapy, patients were divided into 2 groups: EPD (SCD with 50g EPD in 210ml of water four times a day) and SCD (without any supplementation).
Statistical analysis was performed by Student-t-test for continuous and Fisher exact test for categorical variables.
Results: Fifty-eight CD patients underwent surgery in the study period; we recruited 35 CD patients (16 M), treated with ileo-cecal resection. Mean age was 43.8±14.7 years, mean stay in hospital 7.28±3.34 days.
Four patients needed a conversion to laparotomy (2 for a massive abscess, 2 for mesentery retraction); 4 patients needed surgical re-treatment (1 the day after surgery, 1 two weeks later, 1 two months later, 1 three months later); eleven patients had a post-surgical stay in hospital of 8 or more days. Ten patients were treated with EPD and 25 with SCD.
No difference was observed in medical treatment, hemoglobin, serum albumin or BMI values between the two groups before surgery. Patients treated with EPD showed a better outcome in comparison with SCD (p<0.05).
Conclusions: Our results showed that EPD, when administered before surgical ileo-cecal resection in CD patients, seems to prevent complications, improving the outcome during the postoperative course and considerably reducing costs.