Surgical management of Crohn’s disease: a state of the art review

Autor: Christianne J. Buskens, Roel Hompes, W. A. Bemelman, Elise M. van Praag
Rok vydání: 2021
Předmět:
Zdroj: International Journal of Colorectal Disease
ISSN: 1432-1262
0179-1958
DOI: 10.1007/s00384-021-03857-2
Popis: PurposeThe aim of this review was to examine current surgical treatments in patients with Crohn’s disease (CD) and to discuss currently popular research questions.MethodsA literature search of MEDLINE (PubMed) was conducted using the following search terms: ‘Surgery’ and ‘Crohn’. Different current surgical treatment strategies are discussed based on disease location.ResultsSeveral surgical options are possible in medically refractory or complex Crohn’s disease as a last resort therapy. Recent evidence indicated that surgery could also be a good alternative in terms of effectiveness, quality of life and costs as first-line therapy if biologicals are considered, e.g. ileocolic resection for limited disease, or as part of combination therapy with biologicals, e.g. surgery aiming at closure of select perianal fistula in combination with biologicals.The role of the mesentery in ileocolic disease and Crohn’s proctitis is an important surgical dilemma. In proctectomy, evidence is directing at removing the mesentery, and in ileocolic disease, it is still under investigation. Other surgical dilemmas are the role of the Kono-S anastomosis as a preventive measure for recurrent Crohn’s disease and the importance of (non)conventional stricturoplasties.ConclusionSurgical management of Crohn’s disease remains challenging and is dependent on disease location and severity. Indication and timing of surgery should always be discussed in a multidisciplinary team. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease rather than being a last resort therapy.
Databáze: OpenAIRE
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