Comparison of Segmental Vs Total Colectomy for Treatment of Crohn’s Disease

Abstract

Background: There is debate concerning segmental resection for Crohn's disease. Segmental resection is reportedly associated with a greater rate of re-resection as compared to total colectomy. This topic is rarely covered in studies, and postoperative functional result has never been documented. Objective: In this study, the effects of resection, postoperative symptoms, and anorectal function were examined between segmental resection and total colectomy with anastomosis. Material and Methods: This retrospective comparative study was carried out at Department of General Surgery Hayatabad Medical Complex Peshawar from July 2019 to July 2022. Total 70 patients with Crohn's disease limited to the colon or rectum underwent resection were included. Patients were grouped into one of three categories: (a) segmental disease, (b) pancolitis with rectal sparing, or (c) proctocolitis. Recurrences were identified by colonoscopy, barium enema, upper gastrointestinal tract series with small-bowel follow-through, gross examination of bowel at reoperation, or pathologic examination of tissue Results: Total 70 patients were included in the study. Age ranged between 18-65 years with a mean of 41.5 years. There were 40(57.1%) male and 30(42.9%) female, with male to female ratio of 1.3:1. Most common presenting symptoms were pain, diarrhea and anorectal complaints. Initial diagnosis was made through colonoscopy/endoscopy in 50(71.4%) patients and by radiological study in 20(28.6%) patients. Patients were equally divided into 2 groups i.e. group 1 & 2 (35 patients in each group). Group 1 consisted total abdominal colectomy patients while group 2 comprise segmental resection patients. The sites of the cancer occurrence were similar between the two groups, i.e. the proximal colon and distal colon. In group 1, a lower frequency of recurrence was recorded 1 year following surgery when compared with group 2. Conclusion: Although recurrence are most likely, segmental resection improves the quality of life by delaying the need for a stoma and by preserving functioning bowel.