Operationstechniken bei chronisch entzündlichen Darmerkrankungen

Abstract

Surgical Techniques in Inflammatory Bowel Diseases Despite an effective medical therapy, a surgical treatment is required in the majority of patients with Crohn’s disease. In addition, a considerable number of patients will need a reoperation as a result of recurrent Crohn’s disease. Multiple small-bowel resections can lead to a short-bowel syndrome. Therefore, bowel-sparing surgical techniques were developed. They include short segmental bowel resections as well as bowel-preserving strictureplasties. Recent advances in laparoscopic surgery have also introduced a ‘minimally invasive’ surgery in Crohn’s disease. Although medical treatments of both ulcerative colitis and Crohn’s disease are similar, major differences can be noted with regard to the surgical strategy. In patients with ulcerative colitis who do not respond to medical treatment, restorative total proctocolectomy with an ileal pouch is the therapy of choice. This operation can be performed by a conventional laparotomy or, nowadays, also by laparoscopy. However, a poor quality of clinical trials analyzing the current surgical procedures in inflammatory bowel disease does not always allow to draw definite evidence-based conclusions. This article reviews the established surgical procedures in inflammatory bowel disease.