Surgical Treatment of Crohn’s Disease
DOI:
https://doi.org/10.55791/96v82s36Keywords:
Crohn’s disease, fistula., surgical treatmentAbstract
Crohn’s disease is an idiopathic, incurable, chronic, inflammatory disease of the gastro-intestinal tract, whose incidence is rising around the world for unknown reasons. The characteristic transmural inflammation of Crohn’s disease may occur anywhere along the digestive tract, which results in an inflammatory, fibrostenotic or penetrating phenotype. Although the degree of symptomatology varies, and may increase or disappear during the course of the disease, patients may require chronic immuno-suppressive and surgical treatment, but neither of these can cure the disease. Although the rate of surgical interventions for drug-refractory diseases has decreased over the past six decades, as well as the need for urgent surgical procedures, surgery still has an important place in the treatment of the complications of this serious ailment. After resection, which is not curative, 70 to 90% of patients will suffer endoscopic recurrence within one year, and 35% patients will have repeated intestinal resection within ten years.
References
Lightner AL, Vogel JD, Carmichael JC, Keller DS, Shah SA, Mahadevan U, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn’s Disease. Dis Colon Rectum. 2020;63:1028.
Li G, Ren J, Wang G, Hu D, Gu G, Liu S, Ren H, Wu X, Li J. Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn’s disease. Eur J Clin Nutr. 2014;68:441-6.
Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR. Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology. 2003;125:320.
Subramanian V, Pollok RC, Kang JY, Kumar D. Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg. 2006;93:793.
Colombel JF, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, Harmsen WS, Schleck CD, Sandborn WJ. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with
infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99:878.
Lightner AL, McKenna NP, Tse CS, Raffals LE, Loftus EV Jr, Mathis KL. Postoperative outcomes in vedolizumab-treated Crohn’s disease patients undergoing major abdominal operations. Aliment Pharmacol Ther. 2018;47:573.
Lightner AL, McKenna NP, Tse CS, Hyman N,Smith R, Ovsepyan G, et al. Postoperative Outcomes in Ustekinumab-Treated Patients Undergoing Abdominal Operations for Crohn’s Disease. J Crohns Colitis. 2018;12:402.
Ahmed Ali U, Martin ST, Rao AD, Kiran RP. Impact of preoperative immunosuppressive agents on postoperative outcomes in Crohn’s disease. Dis Colon Rectum. 2014;57:663-74.
Lau C, Dubinsky M, Melmed G, Vasiliauskas E, Berel D, McGovern D, Ippoliti A, Shih D, Targan S, Fleshner P. The impact of preoperative serum anti-TNFαtherapy levels on early postoperative outcomes in inflammatory bowel disease surgery. Ann Surg. 2015;261:487.
Pozza A, Scarpa M, Lacognata C, Corbetti F, Mescoli C, Ruffolo C, Frego M, D’IncàR, Bardini R, Rugge M, Sturniolo GC, Angriman I. Magnetic resonance enterography for Crohn’s disease: what the surgeon can take home. J Gastrointest Surg. 2011;15:1689-98.
Siddiki HA, Fidler JL, Fletcher JG, Burton SS, Huprich JE, Hough DM, et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol. 2009;193:113.
Aniwan S, Park SH, Loftus EV Jr. Epidemiology, Natural History, and Risk Stratification of Crohn’s Disease. Gastroenterol Clin North Am. 2017;46:463.
Werbin N, Haddad R, Greenberg R, Karin E, Skornick Y. Free perforation in Crohn’s disease. Isr Med Assoc J. 2003;5:175-7.
Fleshman JW. Pyogenic complications of Crohn’s disease, evaluation, and management. J Gastrointest Surg. 2008;12:2160.
Cellini C, Safar B, Fleshman J. Surgical management of pyogenic complications of Crohn’s disease. Inflamm Bowel Dis. 2010;16:512.
Neufeld D, Keidar A, Gutman M, Zissin R. Abdominal wall abscesses in patients with Crohn’s disease: clinical outcome. J Gastrointest Surg. 2006;10:445.
Tjandra D, Garg M, Behrenbruch C, McCormick J, Simkin P, Prentice R, Trinh A, Al-Ani A, Vaughan R, Macrae F, Christensen B. Review article: investigation and management of internal fistulae in Crohn’s disease. Aliment Pharmacol Ther.2021;53:1064.
Kaimakliotis P, Simillis C, Harbord M, Kontovounisios C, Rasheed S, Tekkis PP. A Systematic Review Assessing Medical Treatment for Rectovaginal and Enterovesical Fistulae in Crohn’s Disease. J Clin Gastroenterol. 2016;50:714.
Taxonera C, Schwartz DA, García-Olmo D. Emerging treatments for complex perianal fistula in Crohn’s disease. World J Gastroenterol. 2009;15:4263.
Duraes LC, Holubar SD. Bowel-Preserving Surgery for Diffuse Stricturing Crohn’s Jejunoileitis. Dis Colon Rectum. 2022;65:1167.
Fumery M, Pineton de Chambrun G, Stefanescu C, Buisson A, Bressenot A, et al. Detection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease and Colonic Strictures. Clin Gastroenterol Hepatol. 2015;13:1770.
Kiran RP, Khoury W, Church JM, Lavery IC, Fazio VW, Remzi FH. Colorectal cancer complicating inflammatory bowel disease: similarities and differences between Crohn’s and ulcerative colitis based on three decades of experience. Ann Surg. 2010;252:330.
Huang R, Valerian BT, Lee EC. Laparoscopic approach in patients with recurrent Crohn’s disease. Am Surg. 2012;78:595-9.
Lee Y, Fleming FJ, Deeb AP, Gunzler D, Messing S, Monson JR. A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn’s disease: an analysis of outcomes from the NSQIP database. Colorectal Dis. 2012;14:572-7.
Hotokezaka M, Jimi SI, Hidaka H, Maehara N, Eto TA, Chijiiwa K. Role of intraoperative enteroscopy for surgical decision making with Crohn’s disease. Surg Endosc. 2007;21:1238.
Michelassi F. Crohn’s recurrence after intestinal resection and anastomosis. Dig Dis Sci. 2014;59:1352-3.
Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Hensley BJ, Noyes K, et al. Missed Opportunity: Laparoscopic Colorectal Resection Is Associated With Lower Incidence of Small Bowel Obstruction Compared to an Open Approach. Ann Surg. 2016;264:127.
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