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Comparison of the results of resection, bypass, and bypass with exclusion for ileocecal Crohn s disease Homan WP; Dineen PAnn Surg 1978[May]; 187 (5): 530-5Controversy continues regarding the optimal surgical treatment of Crohn's disease involving the ileum and cecum. Over 43-years, 161 patients underwent primary surgery for this disease at The New York Hospital-Cornell Medical Center. Resection was performed in 115 patients, bypass with exclusion in 25, and side-to-side ileotranverse colostomy in 21. Overall recurrence rates were 25% for resection, 63% for bypass with exclusion, and 75% for simple bypass. Expressed as 15 year follow-up, recurrence rate were 65% for resection, 82% for bypass with exclusion, and 94% for simple bypass. Much of the difference in final outcome was accounted for by early recurrence or by persistent disease in the two bypass groups. This amounted to 21% for the bypass with exclusion and 45% for simple bypass as compared to 3% for patients who had resection. Conclusions from this review are that 1) resection can be performed with a morbidity and mortality equivalent to either of the bypass procedures; 2) the recurrence rat following resection is significantly lower than bypass with exclusion or simple bypass, and amounts to about 4% per year; 3) continuing disease in the bypassed loop accounts for a high percentage of reoperations in the bypass groups, while appearance of new disease is the usual problem following resection; 4) resection is the surgical treatment of choice for ileocecal Crohn's disease.|Adult[MESH]|Colostomy/*methods[MESH]|Crohn Disease/mortality/*surgery[MESH]|Evaluation Studies as Topic[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Intestinal Fistula/etiology/surgery[MESH]|Postoperative Complications[MESH]|Recurrence[MESH] |