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Recurrence of disease after restorative operation for Crohn's disease is the rule rather than the exception. In fact, studies using colonoscopic surveillance show that minute recurrent lesions appear early on after operation in the majority of patients. Radical extirpation of disease does not reduce the rate of recurrence but only predisposes to the development of short bowel syndrome. Unfortunately, although in preliminary studies some prophylactic drug regimens seem to delay recurrence, no agent has been shown to be sufficiently potent to change this basic picture. Cure is possible in many cases of predominately colonic disease, but this comes at the expense of a permanent ileostomy. Despite these gloomy statistics, 70% or more of patients require one or more operations during their course. This conundrum is managed by using conservative indications for operation and by bowel-conserving operative procedures. Thus employed and carried out, operation has a favorable impact on the quality of life of these patients. Similarly conservative surgical treatment of the perineal complications, which are frequent and devastating, can be of enormous benefit. |
