Health related quality of life after surgery for Crohn's disease.

Crohn’s disease cannot be healed but just taken into remission. Intestinal obstruction and fistulization, lack of response to medical management and perianal disease are the most frequent indication for intestinal surgery. Why is it necessary to measure quality of life after surgery for Crohn’s disease? Firstly, morbidity and mortality provide a partial and, very often, incomplete picture of outcome. Secondarily, nowadays, indications for surgery for Crohn’s disease are broader and not limited to life saving procedures but in many cases they include chronic conditions such as failure of medical therapy, or poor quality of life on it self. Finally, quality of life is a more patient orientated measure of outcome that can give the patients’ point of view about the procedure that is proposed. HRQL is a multi-dimensional concept which includes several dimensions based on biological and symptom variables. Disease-related worries and concerns about the disease on itself and its therapy reflect one of these dimensions and they are considered to be a major determinant of HRQL in patients with IBD. In fact, concerns about having surgery and having an ostomy bag have a relevant impact on HRQL of Crohn’s disease patients and having surgery increases concerns about body stigma. The early impact of surgery on HRQL is an important component of the patient’s decision regarding immediate and future surgery and understanding his or her recovery. Obviously, HRQL is expected to improve after operative procedures. In effect, in most of the studies, a significant improvement in HRQL early in the postoperative period was observed. Improvement, apparently, occurred irrespective of the disease activity measured with CDAI, the indication for surgery, type of procedure (abdominal or perineal), and history of previous surgery. On the contrary, the long-term impact of surgery on HRQL is more controversial. Some studies, mainly those performed with generic questionnaires, reported an improved HRQL while other (those performed with disease specific instruments) described a decreased HRQL. According to these authors, HRQL, apparently, depends mainly on the long-term disease activity.