Segmental resection or subtotal colectomy in Crohn's colitis?

Dis Colon Rectum. 2002 Jan;45(1):47-53. doi: 10.1007/s10350-004-6113-4.


Purpose: Segmental resection for Crohn's colitis is controversial. Compared with subtotal colectomy, segmental resection is reported to be associated with a higher rate of re-resection. Few studies address this issue, and postoperative functional outcome has not been reported previously. This study compared segmental resection to subtotal colectomy with anastomosis with regard to re-resection, postoperative symptoms, and anorectal function.

Methods: Fifty-seven patients operated on between 1970 and 1997 with segmental resection (n = 31) or subtotal colectomy (n = 26) were included. Reoperative procedures were analyzed by a life-table technique. Segmentally resected patients were also compared separately with a subgroup of subtotally colectomized patients (n = 12) with similarly limited colonic involvement. Symptoms were assessed according to Best's modified Crohn's Disease Activity Index and an anorectal function score.

Results: The re-resection rate did not differ between groups in either the entire study population (P = 0.46) or the subgroup of patients with comparable colonic involvement (P = 0.78). Segmentally resected patients had fewer symptoms (P = 0.039), fewer loose stools (P = 0.002), and better anorectal function (P = 0.027). Multivariate analysis revealed the number of colonic segments removed to be the strongest predictive factor for postoperative symptoms and anorectal function (P = 0.026 and P = 0.013, respectively).

Conclusion: Segmental resection should be considered in limited Crohn's colitis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anastomosis, Surgical
  • Child
  • Colectomy*
  • Colitis / etiology*
  • Colitis / physiopathology
  • Colitis / surgery*
  • Colon / physiopathology
  • Colon / surgery
  • Crohn Disease / complications*
  • Crohn Disease / physiopathology
  • Crohn Disease / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Life Tables
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Recovery of Function / physiology
  • Rectum / physiopathology
  • Rectum / surgery
  • Reoperation
  • Treatment Outcome