Surgical management of Crohn’s disease: a state of the art review

Abstract

Purpose The aim of this review was to examine current surgical treatments in patients with Crohn’s disease (CD) and to discuss currently popular research questions. Methods A literature search of MEDLINE (PubMed) was conducted using the following search terms: ‘Surgery’ and ‘Crohn’. Different current surgical treatment strategies are discussed based on disease location. Results Several surgical options are possible in medically refractory or complex Crohn’s disease as a last resort therapy. Recent evidence indicated that surgery could also be a good alternative in terms of effectiveness, quality of life and costs as first-line therapy if biologicals are considered, e.g. ileocolic resection for limited disease, or as part of combination therapy with biologicals, e.g. surgery aiming at closure of select perianal fistula in combination with biologicals. The role of the mesentery in ileocolic disease and Crohn’s proctitis is an important surgical dilemma. In proctectomy, evidence is directing at removing the mesentery, and in ileocolic disease, it is still under investigation. Other surgical dilemmas are the role of the Kono-S anastomosis as a preventive measure for recurrent Crohn’s disease and the importance of (non)conventional stricturoplasties. Conclusion Surgical management of Crohn’s disease remains challenging and is dependent on disease location and severity. Indication and timing of surgery should always be discussed in a multidisciplinary team. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease rather than being a last resort therapy.

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

“…Adequate planning and risk management of CD-related surgery based on the center's experience is critical to reduce surgical complications and in-hospital mortality as well as to increase the patient's quality of life [51,52]. Short bowel syndrome is a complication which needs to be avoided urgently and strategies for bowel preserving surgery such as resecting as little bowel as necessary as well as strictureplasty are well established [29,53]. A further advantage of early surgical intervention is that usually less bowel segments need to be resected, thus, bowel preserving surgery can be performed more easily at early time points of CD.…”

It is not NOD2 — genetic and clinical risk factors for postoperative complications following ileocolic resection in Crohn’s disease

“…About one-third of all CD patients eventually undergo surgery for CD [5]. The most common procedures represent surgery for perianal fistulas and bowel resections [6,7]. Compared to other benign disease, in CD, the rate of postoperative morbidity remains high: a recent prospective study reports a postoperative morbidity rate of 36% [8].…”

Doença de Crohn e retocolite ulcerativa

“…Avanços nos cuidados perioperatórios, como melhora nutricional, anestesia e administração de fluidos e eletrólitos, garantiram melhorias e segurança na cirurgia de DC. A consciência da DC como uma afecção panentérica e, sobretudo, a evidência da inevitável recorrência e possível desenvolvimento da síndrome do intestino curto devido a cirurgias repetidas, sugeriam a adoção de uma política conservadora, evitando ressecções amplas (PETAGNA L, et al, 2020; MEIMA- VAN EMP, et al, 2021).…”