Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn's disease

BACKGROUND/OBJECTIVES: Exclusive enteral nutrition (EEN) has been shown to be effective in the management of Crohn's disease (CD). However, few experiences have been reported regarding its role in postoperative intra-abdominal septic complications (IASCs) after bowel resections for enterocutaneous fistulas (ECFs). Our aim was to investigate the influence of preoperative 3-month EEN on the incidence of IASCs and to clarify the risk factors of IASCs in fistulizing CD. SUBJECTS/METHODS: A retrospective study on 123 CD patients suffering from ECFs was conducted from February 2001 to April 2011. Fifty-five patients (44.7%) received preoperative 3-month EEN. The changes in serum albumin and C-reactive protein (CRP) were compared. Perioperative data were analyzed using logistic regression to identify the independent risk factors affecting the incidence of postoperative IASCs. RESULTS: Patients were similar in gender, age, fistula conditions and perioperative medications in the EEN and non-EEN groups. The EEN group had a significantly higher serum albumin level and lower CRP at operation, and suffered a lower risk of IASCs (3.6% vs 17.6%, P<0.05). Two years after operation when follow-up ended, the two groups had comparable cumulative risk of IASCs (P=0.109). A logistic regression analysis identified age at operation and preoperative EEN as independent risk factors of postoperative IASCs. CONCLUSIONS: Preoperative EEN reduced the risk of postoperative IASCs after operation for ECFs in CD. In addition, age at operation may be another factor of influence.