Surgical Treatment and Outcomes in Patients With Intestinal Behcet Disease: Long-term Experience of a Single Large-Volume Center

Abstract

BACKGROUND: Few studies have examined the surgical treatment of intestinal Behcet disease. Consequently, there is currently no standard surgical treatment for intestinal Behcet disease. Instead, treatment is empirical and symptom based. OBJECTIVE: Our aim was to evaluate the clinical course after surgery and determine the appropriate surgical options for intestinal Behcet disease. DESIGN: Medical charts of patients who underwent surgery for intestinal Behcet were retrospectively reviewed. SETTINGS: The study was conducted at a tertiary referral center. PATIENTS: Ninety-one patients who underwent surgical treatment for intestinal Behcet disease between January 1995 and December 2012 were included in this study. MAIN OUTCOME MEASURES: Primary outcomes measured were patient demographics, clinical characteristics, operative and postoperative outcomes, and long-term follow-up data. RESULTS: Surgical treatment was mainly in response to intractability to medical treatment (56.0%), and 19.8% of patients underwent an emergency operation. Surgery was performed laparoscopically in 33.0% of the patients. Most patients received an ileocecectomy (39.6%) or a right hemicolectomy (34.1%). Twenty-eight patients (30.8%) experienced postoperative morbidities, and 8 patients (8.8%) required reoperations. There were 3 deaths. Reoperation was required for recurrent disease in 32 patients during the long-term follow-up, and the 5-year cumulative reoperation rate was 31.2% (95% CI, 20.4%-42.0%). Among those requiring a second operation, 53.1% were segmental colonic resections that included the previous anastomosis. From multivariable Cox regression analysis, independent predictors of surgical recurrence included postoperative use of steroids (HR = 2.85 (95% CI, 1.21-6.75); p = 0.02), postoperative complications (HR = 2.42 (95% CI, 1.12-5.22); p = 0.03), and BMI (HR per 1-kg/m(2) increase in BMI = 0.90 (95% CI, 0.82-0.99); p = 0.04). LIMITATIONS: This study was designed retrospectively and had a small sample size. CONCLUSIONS: Patients treated surgically for intestinal Behcet disease frequently have postoperative complications and the need for a stoma and have a high risk of recurrence.