180 ‘Early’ surgery for ileocaecal Crohn’s disease: a study of the patient perspective

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Abstract Background Surgery for Crohn’s disease (CD) is considered when medical therapy is unsuccessful. Evidence shows that earlier bowel resection offers more stable remission for localised luminal ileocaecal disease. The adoption of earlier surgery into practice is challenging. We aimed to establish the acceptability of, and barriers to, early surgery from a patient perspective through a multicentre qualitative study. Methods Patients with ileocaecal CD from 8 centres across the UK (including both specialist IBD centres and non-specialist hospitals) were recruited, using purposive sampling, to participate in semi-structured interviews, until data saturation was achieved. Results Twenty-nine participants were interviewed (17 with a previous resection). Fear of surgery was one of the dominant themes, even amongst patients with a good surgical outcome, driven by the risk of a stoma and the potential for complications. Participants reported that surgery was not offered to them until they had tried several drugs or disease complications arose. Reportedly, surgery was commonly framed negatively by clinicians. Conclusion This is the first study investigating the gap between the evidence-base and clinical practice relating to the management of luminal ileocaecal CD. In our previous study investigating the clinician perspective, clinician-participants were proponents of early surgery. By contrast, patients in this study reported being offered a resection late in the pathway. Surgery should be discussed sooner with patients to provide clear information about treatment. Patients may still be reluctant to have surgery when medical options exist. This has implications for the design of future trials of surgical treatment for ileocaecal CD.

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