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Invited Critique
January 2010

Preventing Crohn Disease Recurrence With Drugs After Ileocolectomy: An Exercise in Futility?Comment on “Recurrence and Impact of Postoperative Prophylaxis in Laparoscopically Treated Primary Ileocolic Crohn Disease”

Arch Surg. 2010;145(1):47-48. doi:10.1001/archsurg.2009.249

Malireddy and colleagues from the Mayo Clinic conducted this retrospective record review to assess whether postoperative administration of anti-inflammatory agents lowered the risk of recurrence after laparoscopic ileocolectomy for Crohn disease. Of the 109 patients identified as having had the procedure, 89 were followed up postoperatively for a median of 3.5 years. The authors identified 54 patients (61%) who had recurrence at a median of 13.1 months as detected endoscopically, radiologically, or histologically. Apparently, to look for recurrence, endoscopy was performed at any time postoperatively for anyone who was symptomatic and at 12 to 18 months for anyone who was not symptomatic. Only 44 of the patients (49%) whom they followed up postoperatively received any kind of prophylaxis (most commonly AZA/6-MP). There was no significant difference in recurrence between those who received the prophylaxis (37.5%) and those who did not (52.6%), although there appeared to be a trend toward efficacy in the prophylaxis group.

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