The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn’s Disease

Inflammatory bowel disease (IBD) consists of two diseases: ulcerative colitis (UC) and Crohn's disease (CD). The incidence of IBD is much higher in Western countries compared to Asian countries, especially in Thailand. The incidence of UC in Thailand is quite low and seems less aggressive than in Western countries. Over the past two decades, the evolution of UC management in Thailand has led to a reduction in hospitalization and colectomy rate. Regarding CD, the majority of patients have an inflammatory phenotype at diagnosis. Diagnosis of CD remains challenging in Thailand as the time from onset of symptoms to diagnosis is quite delayed, possibly due to unawareness and difficulty in the differential diagnosis between CD and other infectious entero‐colitis such as intestinal tuberculosis. With a significant trend to early initiation of immunomodulators and biologics, the cumulative rate of surgery after diagnosis has been improved. To improve the outcomes of CD treatment in Thailand, physicians need more awareness to recognize the disease, which results in early diagnosis, prevention of long‐term complications, and reduction in the rate of surgery.

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“…Although complications do not increase, conversion to open surgery was 2.5 times more frequent in recurrent cases. 28 , 29 …”

Section: Crohn's Diseasementioning

confidence: 99%

Current status of IBD and surgery of Crohn's disease in Thailand

Riansuwan

Limsrivilai

2021

Annals of Gastroent Surgery

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“…Currently, a wide lumen configuration with a stapled side-to-side anastomosis is favored as it may prevent early stenosis, colonic reflux, fecal stasis, and secondary ischemia and has been associated with reduced overall postoperative complications, especially anastomotic leaks [66][67][68][69]. However, the American Society of Colon and Rectal Surgeons (ASCRS) guidelines published in 2020 suggest that reconstruction following ileocecal resection using side-to-side, side-to-end, or end-to-end handsewn or stapled anastomosis should be based on surgeon preference and experience, as the data regarding anastomotic technique, leak, and recurrence are conflicting (strong recommendations based on low-quality evidence) [70].…”

Section: Surgical Methods and Postoperative Recurrencementioning

confidence: 99%

What’s New in the Postoperative Management of Crohn’s Disease?

2021

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Patients with Crohn's disease (CD) often require surgical resection due to complications, such as strictures and abscesses, or disease refractory to medical therapy. To understand the evolving management of patients with CD after surgery, we outline the risk factors for postoperative recurrence, advances in postoperative endoscopic evaluation and characterization of recurrence, noninvasive methods of assessing postoperative recurrence, use of postoperative prophylactic medical therapy including newer biologics, and novel surgical methods to reduce postoperative recurrence. The Rutgeerts score (RS) was developed to predict progression of disease based on endoscopic appearance postoperatively and to guide medical therapy. However, this scoring system groups ileal and anastomotic lesions into the same category. A modified RS was developed to separate lesions isolated to the anastomosis and those in the neo-terminal ileum to further understand the role of anastomotic lesions in CD progression. Additional scoring systems have also been evaluated to better understand these differences. In addition, noninvasive diagnostic methods, such as small bowel ultrasound, have high sensitivity and specificity for the detection of postoperative recurrence and are being evaluated as independent methods of assessment. Studies have also shown a reduction in endoscopic recurrence with postoperative anti-TNFα therapy. However, preoperative exposure to anti-TNFα therapy may impact postoperative response to these medications, and therefore, determining optimal postoperative prophylaxis strategy for biologic-experienced patients requires further exploration. Lastly, new surgical modalities to reduce postoperative recurrence are currently being investigated with preliminary data suggesting that an antimesenteric functional end-to-end anastomosis (Kono-S) may decrease postoperative recurrence.

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“…Crohn's disease (CD) is an idiopathic, incurable chronic inflammatory disease of the GI tract [92][93][94][95], associated in more than 30% of cases to symptoms of perianal disease (PAD) [96][97][98]. The risk of developing PAD is consistent with the time from the diagnosis of CD, from 20% after ten years and up to 30% after twenty years.…”

Section: Perianal Crohn's Diseasementioning

confidence: 99%

Ambulatory Surgery for Perianal Disease

Divizia¹,

Sica²

2022

Ultimate Guide to Outpatient Care

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The gold standard in the diagnosis and treatment of proctological diseases is the exploration of the anal canal and distal rectum under anaesthesia (EUA), routinely performed as day case surgery. In selected cases it can be conducted as an outpatient exploration (OE) during a specialist surgical consultation. In the outpatient setting it is possible and safe to perform rubber band ligation, sclerotherapy and infrared coagulation for the treatment of haemorrhoidal disease, excision and incision of thrombosed external haemorrhoids, abscess drainage, setonage and fistulotomy also in case of perianal Crohn’s disease, anal warts and skin tags removal. In terms of patients’ satisfaction and success rate OE is comparable to EUA. All procedures can be performed under local anaesthesia. Pain control after the procedure is provided by oral pain killers.

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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn’s Disease

Cited by 83 publications

References 292 publications

Current status of IBD and surgery of Crohn's disease in Thailand

Current status of IBD and surgery of Crohn's disease in Thailand

What’s New in the Postoperative Management of Crohn’s Disease?

Ambulatory Surgery for Perianal Disease

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