PMID: 9162602Jan 1, 1995Paper

Prevention of infectious postoperative complications in Crohn's disease

Chirurgia italiana
F FicariF Tonelli

Abstract

Mortality and post-operative complications are elevated in Crohn's disease, for many reasons: pre-existing septic complications, malnutrition, impaired cell-mediated immunity, failure to identify enteric fistulas and/or abdominal abscess during surgical operation. From 1984 to 1996 in 383 patients with Crohn's disease we performed 426 surgical procedures, observing post-operative complications in 28 of these (6.5%). However, septic complications in the surgical field were only 7 (1.6%). A 83-year-old patient died after surgery because of heart failure. The risk of post-operative complications was significantly higher in patients with elevate Prognostic Nutritional Index (PNI). We treated patients with malnutrition pre-operatively using parenteral nutrition (TPN). In 100 patients undergoing TPN we observed a significant PNI reduction (from 53.3 +/- 13 to 42.1 +/- 6.9) and a significative improvement of transport proteins correlated with nutritional status, such as pre-albumin (from 21.2 mg/dl +/- 9.8 to 26.5 mg/dl +/- 7.8) and retinol binding protein (from 3.8 mg/dl +/- 1.6 to 4.6 mg/dl +/- 1.7). During surgical operations we recorded fistulas caused by disease, observing 336 fistulas in 258 patients. The treatment of fistulas (...Continue Reading

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