Back to Annual Meeting Program

Objective: To determine predictors of length of small bowel resection in patients undergoing ileocecectomy for Crohn’s disease.
Design: Cohort study from prospectively gathered database.
Setting: Two academic tertiary care centers.
Patients: 269 patients who underwent ileocecal resection for Crohn’s disease between 1993 and 2010 at the Massachusetts General Hospital and the New York Hospital of Cornell University. Mean age was 39 years and 51 % were female.
Interventions: Ileocecal resection.
Main outcome measure: Length of small bowel resection.
Results: Length of small bowel resection was 20.8 ± 17.2cm. On univariate analysis, there were no statistically significant differences in resected length when comparing age, sex, disease type (fibrostenotic, inflammatory or penetrating), or treatment with immunomodulators. Resection length was no different if patients underwent emergent surgery or had prior resection. Malignancy led to longer length of resection (54.7 Vs 19.6cm, p 0.001). There was a statistically significant increase in length of resection if the procedure was performed by a non-expert (29.5 Vs 19.9 cm, p 0.008). Expert was defined as one who performs over 15 Crohn’s operations per year or is a trained colorectal surgeon. Multivariate linear regression analysis revealed the following statistically significant predictors of longer resection: prior resection (OR 6.32, 95% CI 2.8-9.7, p 0.0004), malignancy (OR 10.8, 95% CI 1.97-19.5, p 0.0002), and surgery by non-expert (OR 7.63, 95% CI 3.7-11.7, p 0.0002).
Conclusions: In this study, the only modifiable factor to reduce length of small bowel resection in Crohn’s was surgeon expertise. This raises the question of whether surgical treatment of Crohn’s should be handled by trained colorectal surgeons or general surgeons with extensive experience in the care of these challenging patients.