The influence of early operative treatment on postoperative recurrence in patients with Crohn’s disease of the ileocecal region

Abstract

Introduction/Objective Crohn’s disease was traditionally managed by gastroenterologists, but in the past decade, the surgeon’s role has expanded, with specialized inflammatory bowel disease surgeons now integral to multidisciplinary decision-making. Evidence indicates that early ileocecal resection for localized terminal ileitis with a predominantly fibrotic component, performed before complications arise, may improve outcomes and reduce disease-related morbidity. The aim of this study is to evaluate the impact of early ileocecal resection with Kono-S anastomosis on postoperative disease control in patients with localized Crohn’s disease, by assessing changes in inflammatory biomarkers, clinical symptoms, and endoscopic recurrence over a two-year follow-up period.

Methods From 2021 to 2023, all patients in this study were assessed by the Inflammatory Bowel Disease Multidisciplinary Team of the University Clinical Center of Vojvodina, which determined indications for surgery. Postoperative recurrence was monitored clinically and endoscopically using colonoscopy and the Rutgeerts score. Sixty patients underwent laparoscopic ileocecal resection with Kono-S anastomosis.

Results Statistical analyses (IBM SPSS 26) used repeated-measures ANOVA at three time points: preoperatively, one year postoperatively, and two years postoperatively. Fecal calprotectin showed a strong time effect (F(1.77, 104.51) = 300.13, p < 0.001, ηₚ² = 0.84), demonstrating substantial reduction in intestinal inflammation. Defecation difficulty scores also decreased significantly (F(1.43, 84.28) = 136.36, p < 0.001, ηₚ² = 0.70). Rutgeerts scores showed no significant change between years one and two (F(1, 56) = 3.11, p > 0.05), indicating stable endoscopic findings.

Conclusion Endoscopic monitoring with the Rutgeerts score, supported by fecal calprotectin, proved most reliable for postoperative surveillance. With careful multidisciplinary selection – especially in patients with localized, fibrotic disease – early ileocecal resection using the Kono-S technique can effectively control Crohn’s disease, decrease rehospitalizations and reoperations, and improve quality of life.

Keywords: Crohn’s disease; surgical treatment; ileocecal resection; Kono-S anastomosis; Rutgeerts score