Surgical Planning in Penetrating Abdominal Crohn's Disease

Abstract

Crohn's disease (CD) is increasing globally, and the disease location and behavior are changing toward more colonic as well as inflammatory behavior. Surgery was previously mainly performed due to ileal/ileocaecal location and stricturing behavior, why many anticipate the surgical load to decrease. There are, however, the same time data showing an increasing complexity among patients at the time of surgery with an increasing number of patients with the abdominal perforating disease, induced by the disease itself, at the time of surgery and thus a more complex surgery as well as the post-operative outcome. The other major cause of abdominal penetrating CD is secondary to surgical complications, e.g., anastomotic dehiscence or inadvertent enterotomies. To improve the care for patients with penetrating abdominal CD in general, and in the peri-operative phase in particular, the use of multidisciplinary team discussions is essential. In this study, we will try to give an overview of penetrating abdominal CD today and how this situation may be handled. Proper surgical planning will decrease the risk of surgically induced penetrating disease and improve the outcome when penetrating disease is already established. It is important to evaluate patients prior to surgery and optimize them with enteral nutrition (or parenteral if enteral nutrition is ineffective) and treat abdominal sepsis with drainage and antibiotics.

Preoperative Optimization of Crohn's Patients before Abdominopelvic Surgery

“…5,82 In addition, the presence of a phlegmon or an abscess reduces the likelihood of a minimally invasive approach to surgery. 83 Therefore, it is imperative to control abscesses and phlegmons prior to any surgical intervention. This can be achieved via broad-spectrum antibiotics and percutaneous drainage (PD) catheter placement.…”

“…5 82 In addition, the presence of a phlegmon or an abscess reduces the likelihood of a minimally invasive approach to surgery. 83…”

Minimally Invasive Management of Complicated and Re-operative Crohn's Disease

“…2 3 Additionally, 30% of patients who undergo surgical intervention for Crohn's disease will require additional surgical intervention within 10 years of their index operation. 4 5 High likelihood of surgery for these patients requires continuous improvement in surgical techniques to benefit complicated and recurrent disease.…”

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

“…Regarding the penetrating type of the disease, it is argued that appropriate surgical planning is expected to reduce the risk of penetrating disease caused by the disease itself or at the time of surgery, while it is expected to improve the disease in cases of already established penetrating disease. To achieve this goal, a careful preoperative evaluation of the patient should be performed, an improvement of the nutritional status should be achieved using enteral or parenteral nutrition, and any coexisting septic complication should be appropriately treated[ 47 ].…”