Clinical literature review of 1858 Crohn's disease cases requiring surgery in China

Table 1 Summary of the surgical indications n (%)

Surgical indication	Cases
Intestinal obstruction or stricture	443 (23.84)
Peritonitis or other acute abdominal disease	250 (13.46)
Abdominal mass	203 (10.93)
Intestinal fistulae1	184 (9.90)
Internal fistulae	62 (3.34)
External fistulae	45 (2.42)
Vaginal fistulae	5 (0.27)
Vesical fistulae	15 (0.81)
Other unclassified fistulae	58 (3.12)
Intestinal perforation	157 (8.45)
Perianal disease2	125 (6.73)
Perianal abscess	22 (1.18)
Perianal fistulae	61 (3.28)
Perianal fissure	4 (0.22)
Perianal ulcer	2 (0.11)
Perianal fistulae and fissure	10 (0.54)
Perianal fistulae and ulcer	5 (0.27)
Other unclassified perianal disease	21 (1.13)
Gastrointestinal bleeding	89 (4.79)
Abdominal abscess	75 (4.04)
Intestinal adhesion	50 (2.69)
Failure of drug therapy	275 (14.80)
Pyloric obstruction	4 (0.22)
Colic intussusception	3 (0.16)

¹The percentage of each type of fistulae in 1858 cases;

²The percentage of each perianal disease in 1858 cases.

Table 2 Summary of the surgical procedures n (%)

Surgical procedure	Cases
Ileal resection	420 (22.60)
Colonic resection	451 (24.27)
Total proctocolectomy	5 (0.27)
Partial colectomy	446 (24.00)
Right hemicolectomy	229 (12.33)
Ileocecal resection	99 (5.33)
Left hemicolectomy	45 (2.42)
Rectal resection	11 (0.59)
Transverse colonic resection	7 (0.38)
Other colonic resection (unclassified)	55 (2.96)
Ileocolonic resection	190 (10.23)
Other unclassified bowel resection	221 (11.89)
Upper gastrointestinal resection	10 (0.54)
Operation for perianal disease	90 (4.84)
Ileostomy or colostomy	76 (4.09)
Operation for fistulae or perforations	56 (3.01)
Drainage of an abdominal abscess	11 (0.59)
Abdominal exploration	39 (2.10)
Small intestinal colon short circuit	24 (1.29)
Stricturoplasty	9 (0.48)
Intestinal adhesion release	9 (0.48)
Operation for a complicated tumor	4 (0.22)
Other or unclassified surgery	223 (12.00)

Although rare, some patients underwent more than one surgical procedure simultaneously.

Table 3 Surgical complications of 322 cases n (%)

Surgical complication	Cases
Infection	127 (39.44)
Incision infection	88 (27.33)
Abdominal infection	17 (5.28)
Other infection	22 (6.83)
Intestinal fistula	84 (26.09)
Death	60 (18.63)
Stricture or stenosis	39 (12.11)
Intestinal adhesion	11 (3.42)
Abdominal abscess	14 (4.35)
Gastrointestinal bleeding	13 (4.04)
Stress ulcer	9 (2.80)
Incision fat liquefied	4 (1.24)
Short bowel syndrome	3 (0.93)
Gastrointestinal perforation	2 (0.62)
Incision fissure	2 (0.62)
Others or unclassified	25 (7.76)

The patients may have experienced more than one complication simultaneously.

Table 4 Summary of the clinical characteristics of Groups A and B n (%)

Surgery characteristics	Group A(n = 447)	Group B(n = 620)	P value
Gender ratio (male/female)	262/185	375/245	0.539
Mean age	38.46	37.78	-
Disease location1			< 0.001
L1	166 (53.21)	126 (29.37)	< 0.001
L2	82 (26.28)	111 (25.87)	0.901
L3	54 (17.31)	179 (41.72)	< 0.001
Upper gastrointestinal disorder involvement	10 (3.21)	13 (3.03)	0.892
Surgical indication			< 0.001
Intestinal obstruction or stricture	92 (20.58)	205 (33.06)	< 0.001
Abdominal mass	44 (9.84)	36 (5.81)	0.013
Perianal disease	0 (0.00)	97 (15.65)	< 0.001
Intestinal fistulae	7 (1.57)	68 (10.97)	< 0.001
Intestinal adhesion	0 (0.00)	12 (1.94)	0.003
Gastrointestinal bleeding	2 (0.45)	26 (4.19)	< 0.001
Abdominal abscess	11 (2.46)	30 (4.84)	0.046
Intestinal perforation	22 (4.92)	46 (7.42)	0.099
Peritonitis or other acute abdominal diseases	21 (4.70)	17 (2.74)	0.089
Failure of drug therapy	248 (55.48)	83 (13.39)	< 0.001
Diagnosis of CD before surgery			< 0.001
Certain	137 (30.65)	194 (31.29)	0.689
Misdiagnosis2	156 (34.90)	75 (12.10)	< 0.001
Intestinal tuberculosis	22 (14.10)	2 (2.67)	0.008
UC	8 (5.13)	6 (8.00)	0.574
Tumor	49 (31.41)	23 (30.67)	0.909
Acute appendicitis	77 (49.36)	44 (58.67)	0.185
Uncertain	154 (34.45)	351 (56.61)	< 0.001
Surgical procedure
Bowel resection	312 (69.80)	430 (69.35)	0.876
Colonic resection	83 (18.57)	105 (16.94)	-
Ileal resection	65 (14.54)	175 (28.23)	-
Ileocolonic resection	40 (8.95)	105 (16.94)	-
Upper gastrointestinal resection	8 (1.79)	1 (0.16)	-
Unclassified bowel resection	126 (28.19)	44 (7.10)	-
Operation for perianal disease	0 (0.00)	81 (13.06)	< 0.001
Ileostomy or colostomy	6 (1.34)	27 (4.35)	0.005
Stricturoplasty	1 (0.22)	8 (1.29)	0.123
Complication of surgery3	68 (18.94)	133 (24.23)	0.061
Infection	21 (30.88)	60 (45.11)	0.052
Stricture or stenosis	14 (20.59)	24 (18.05)	0.663
Death	16 (23.53)	7 (5.26)	0.708
Intestinal fistulae	9 (13.24)	28 (21.05)	< 0.001
Abdominal abscess	5 (7.35)	5 (3.76)	0.176
Surgical relapse rate4	115 (31.59)	126 (28.64)	0.362
Surgery after relapse	38 (33.04)	34 (26.98)	0.305

¹There were 312 cases and 429 cases for which the disease location was reported in Groups A and B, respectively;

²Misdiagnosis was retrospectively analyzed furtherly;

³There were 359 cases and 549 cases in Groups A and B, respectively, who experienced surgical complications; the distribution of these complications was further analyzed;

⁴There were 364 cases and 440 cases in Group A and B, respectively, which contained follow-up data. P < 0.05 was considered to be significant. L1: Small intestine; L2: Colon; L3: Small intestine and colon; UC: Ulcerative colitis.