Drei Dekaden Darmresektionen bei Patienten mit M. Crohn

Zusammenfassung

Einleitung Die Behandlung des M. Crohn – vor allem die medikamentöse – erlebte in den letzten 20–30 Jahren einen starken Wandel. Die vorliegende Beobachtungsstudie fasst alle Darmresektionen wegen M. Crohn zusammen, die in den letzten 3 Dekaden an 2 großen spezialisierten Zentren durchgeführt wurden. Die perioperativen Trends und Entwicklungen sollten identifiziert werden.

Methoden Eingeschlossen wurden alle Darmresektionen bei M. Crohn. Ausschlusskriterien waren: Resektionen bei Malignität, abdominoperineale Rektumexstirpationen wegen Crohn-Analfisteln, ausschließliche Stomaanlagen und -rückverlagerungen und Resektionen, die einen anderen Grund als M. Crohn hatten. Die Daten wurden von 1992 bis 2004 retrospektiv und danach prospektiv gesammelt. Ausgewertet wurden 6 Zeiträume: 1992–1995, 1996–2000, 2001–2005, 2006–2010, 2011–2015 und 2016–2020.

Ergebnisse Es wurden 811 Darmresektionen ausgewertet. Zwischen 2000 und 2015 konnten gleich mehrere sehr starke Trends beobachtet werden: erhöhte präoperative Einnahme von Immunmodulatoren und Biologika, sinkende präoperative Steroideinnahme, Verzicht auf präoperative Darmvorbereitung, erhöhter Anteil an voroperierten Patienten und Patienten, die sich mit penetrierendem Befallsmuster vorstellten, Einführung neuer Operationstechniken (Laparoskopie, Stapleranastomosen) und signifikante Erhöhung der postoperativen Morbidität und Stomachirurgie. In den letzten 5 Jahren seit 2016 zeigten sich folgenden Entwicklungen: signifikant weniger Operationen unter Steroideinnahme oder Immunmodulatoren, signifikant mehr Operationen unter Biologika, Wiedereinführung der präoperativer Darmvorbereitung, starke Reduktion der Morbidität und Stomaanlage, höheres Alter der Patienten, weniger aktive Raucher, weniger Operationen wegen penetrierenden Befallsmusters, sehr starker Anstieg laparoskopischer Operationen.

Schlussfolgerung Vor allem in den letzten 5 Jahren scheint die Crohn-Chirurgie wesentlich sicherer und weniger invasiv zu werden. Die Daten können jedoch nicht auf größere Populationen übertragen werden.

Abstract

Background The present observational study demonstrates developments of surgery in Crohn’s disease patients undergoing bowel resection at two tertiary referral centers during the recent 3 decades.

Methods Consecutive patients undergoing intestinal resections were included. Exclusion criteria were: resection for malignancy, mere stoma formation and closure, bowel resections for other reasons than Crohn’s disease, abdomino-perineal resections for anal fistula. Data collection was retrospective between 1992 and 2004, and prospective thereafter. Six time periods were compared: 1992–1995, 1996–2000, 2001–2005, 2006–2010, 2011–2015, and 2016–2020.

Results Between 2000 and 2015 several significant developments could be observed: decline in preoperative steroid intake, increase in preoperative intake of immunomodulators and biologic agents; abandonment of preoperative mechanical bowel preparation, increase in surgery for penetrating disease and more patients with previous bowel resections, increase in laparoscopy use, stoma rate and postoperative morbidity. Since 2016, mechanical bowel preparation and oral antibiotics were (re)introduced, there was significantly more laparoscopic surgery (67%), preoperative steroid and immunomodulator intake diminished, whereas preoperative biological therapy increased; patients were older and less were active smokers; stoma formation rate and morbidity rate decreased significantly.

Conclusion There were several very strong trends in Crohn’s disease surgery during the last 3 decades. However, present results cannot be generalized to broader patient’ population.

Schlüsselwörter

M. Crohn - Chirurgie - Darmresektion

Keywords

Crohn’s disease - Surgery - Bowel resection

Publication History

Received: 01 January 2021

Accepted after revision: 11 April 2021

Article published online:
23 June 2021

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