Inflammatory bowel disease surgery in the biologic era

Abstract

Anti-tumour necrosis factor (TNF)-α therapy has revolutionized inflammatory bowel disease (IBD) treatment. Infliximab and adalimumab either as monotherapy or in combination with an immunomodulator are able to induce clinical and biological remission in patients with moderate and severe Crohn's disease (CD) and ulcerative colitis (UC). These new therapies have led to a shift in the goals of IBD management from just controlling clinical symptoms to preventing disease progression. However, despite these advances in medical therapy, surgery is still required in 30%-40% of patients with CD and 20%-30% of patients with UC at some point during their lifetime. While biologics certainly play a major role in the medical treatment of IBD, there is concern about the effects of these anti-TNF-α agents on postoperative complications and morbidity. The purpose of this article is to review the role of surgery in the treatment of IBD in the age of biologics and the impact of these medications on per-operative outcomes. In this manuscript we review the relationship between biologic agents and surgery in the treatment of IBD. We also discuss in detail the periopetative risks and complications.

Regional differences in anti-TNF-α therapy and surgery in the treatment of inflammatory bowel disease patients: a Norwegian nationwide cohort study

“…1,2 However, the effect on the disease's long-term course is not sufficiently clarified and remains an active research area. [3][4][5] A substantial proportion of patients do not achieve remission with biologics; others lose response or experience adverse reactions. Failure of medical therapy is the most common indication for surgery, but surgery can also be an option without having failed medical therapy.…”

Short-term Outcomes of Elective 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Does Laparoscopy Have Benefits?

“…Several mechanisms of postoperative ileus have been proposed in previous studies [17]. Bowel manipulation can lead to traumatic injury, bowel adhesions, and slower blood flow to the mesentery and bowel wall [18,19]. Previous studies demonstrated that intraperitoneal procedures in laparoscopic surgery are performed with relatively minimal manipulation compared to open surgery [18,20]; the lower incidence of postoperative ileus in the laparoscopic group of this study may reflect this.…”

Applying Enhanced Recovery Pathways to Unique Patient Populations

“…Approximately 70 to 80% of patients with Crohn's disease and 20 to 30% of patients with ulcerative colitis require surgery during their lifetime. 17 Patients with IBD who require surgery usually have failed multiple medical therapies such as steroids, mesalamine, infliximab and other biologics, azathioprine, and methotrexate, and often have developed complications such as perforation, fulminant colitis, recurrent abscesses, strictures, and enteric fistulae. As such, these patients are at high risk for postoperative complications.…”