Resultados de la cirugía en enfermedad inflamatoria intestinal: experiencia en un centro de atención terciaria

Introduction. The development of the therapeutic arsenal in inflammatory bowel disease has reduced the need for surgery in these patients. However, in certain cases, it continues to be the treatment of choice. In addition, the patients who required surgery intervention are more complex due to the therapy received (corticosteroids and immunomodulators) and the time of evolution of the disease. Materials and methods. We included patients under stable follow-up, in the Inflammatory Bowel Disease Unit of our center, who required surgery between January 2015 and November 2016 for treatment of the underlying pathology. Demographic and baseline disease variables were collected from each patient, as well as those related to the results and safety of the surgery, assessing both early and delayed complications. Results. During the study period, among the 998 patients with stable follow-up in the Inflammatory Bowel Disease Unit, 26 of them underwent surgery representing 2.6% of the sample. 85% of patients were on treatment with an immunomodulator (thiopurines, antiTNF or both) at the time of surgery. Five patients (20%) presented early postoperative complications, most of them mild (Claiven-Dindo I 79.2% and II 16.7%), of whom three (60%) were on combined treatment with azathioprine and an anti-TNF. No deferred complications of surgery were observed during its subsequent evolution. In the patients who underwent abdominal surgery, multivariate analysis showed that the presence of immunosuppressive treatment -at the time of surgery- increased the risk of suffering complications with an odds ratio of 1.66, and the treatment with biliologics, with an odds ratio of 1.457. None of the patients -in whom a complication occurred- were on corticosteroids treatment at the time of surgery. Conclusion. In our experience, the frequency surgery-related complications are low, despite the increasing use of immunosuppressive drugs in our patients.