Surgical management of inflammatory bowel disease

  • Robert R. Cima
  • John H. Pemberton
Article

Opinion statement

Surgery continues to be a central component in the treatment of patients with inflammatory bowel disease (IBD). The most important aspect of caring for patients with IBD is a close and ongoing interaction between the surgeon and gastroenterologist both before and after surgery. Surgery in patients with chronic ulcerative colitis (CUC) is curative. In the appropriate patient, we recommend proctocolectomy with ileal pouch anal anastomosis (IPAA). In contrast, patients with Crohn’s disease cannot be cured with surgery. Instead, surgery is used in conjunction with maximal medical therapy to treat symptoms of the disease and improve the patient’s quality of life. Surgical interventions should be limited in scope. Small bowel disease should be treated with either limited resection or strictureplasty, if possible, to conserve bowel length. For limited involvement of the colon, segmental resection yields good results. Minimal surgical intervention, drainage of abscesses, placing draining setons, and aggressive medical therapy is recommended as treatment of perianal Crohn’s disease.

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References and Recommended Reading

  1. 1.
    Becker JM: Surgical therapy for ulcerative colitis and Crohn’s disease. Gastroenterol Clin N Am 1999, 28:371–390.CrossRefGoogle Scholar
  2. 2.
    Truelove SC, Witts LF: Cortisone in ulcerative colitis: final report on a therapeutic trial. Br Med J 1955, 2:1041–1048.PubMedCrossRefGoogle Scholar
  3. 3.
    Gurudu SR, Griffel LH, Gialanella RJ, Das RM: Cyclosporine therapy in inflammatory bowel disease: short-term and long-term results. J Clin Gastroenterol 1999, 29:151–154.PubMedCrossRefGoogle Scholar
  4. 4.
    Lewis JD, Deren JJ, Lichenstein GR: Cancer risk in patients with inflammatory bowel disease. Gastroenterol Clin N Am 1999, 28:459–477.CrossRefGoogle Scholar
  5. 5.
    Gorfine SR, Bauer JJ, Harris MT, Kreel I: Dysplasia complicating chronic ulcerative colitis: is immediate colectomy warranted. Dis Colon Rectum 2000, 43:1575–1581.PubMedCrossRefGoogle Scholar
  6. 6.
    Hurst RD, Molinari M, Chung TP, et al.: Prospective study of the features, indications, and surgical treatment in 513 consecutive patients affected by Crohn’s disease. Surgery 1997, 122:661–668. Good overview of the reasons for operation and reoperation in patients with Crohn’s disease.PubMedCrossRefGoogle Scholar
  7. 7.
    Fazio V, Marchetti F, Chruch JM, Goldblum JR: Effect of resection margins on recurrence of Crohn’s disease in small bowel: a randomized controlled trial. Ann Surg 1996, 224:563–573. Article on a large series of patients enrolled in a prospective fashion, designed to address an important clinical question.PubMedCrossRefGoogle Scholar
  8. 8.
    Borely NR, Mortensen NJ, Jewell DP: Preventing postoperative recurrence of Crohn’s disease. Br J Surg 1997, 84:1493–1502.CrossRefGoogle Scholar
  9. 9.
    McLeod RS, Wolff BG, Steinhart AH, et al.: Risk and significance of endoscopic/radiological evidence of recurrent Crohn’s disease. Gastroenterology 1997, 113:1823–1827.PubMedCrossRefGoogle Scholar
  10. 10.
    Camma C, Giunta M, Rosselli M, Cottone M: Mesalamine in the maintenance treatment of Crohn’s disease: meta-analysis adjusted for confounding variables. Gastroenterology 1997, 113:1465–1473.PubMedCrossRefGoogle Scholar
  11. 11.
    Ozuner G, Fazio VW, Lavery IC, et al.: Reoperative rates for Crohn’s disease following strictureplasty: longterm analysis. Dis Colon Rectum 1996, 39:1199–1203.PubMedCrossRefGoogle Scholar
  12. 12.
    Prabhakar LP, Laramee C, Nelson H, Dozois RR: Avoiding a stoma: role for segmental or abdominal colectomy in Crohn’s colitis. Dis Colon Rectum 1997, 40:71–78.PubMedCrossRefGoogle Scholar
  13. 13.
    Sangwan YP, Schoetz DJ, Murray JJ, et al.: Perianal Crohn’s disease. Results of local surgical treatment. Dis Colon Rectum 1996, 39:529–535.PubMedCrossRefGoogle Scholar
  14. 14.
    Yu Chang S, Pemberton JH, Larson D: Ileal pouch-anal anastomosis in patients with indeterminate colitis: long term results. Dis Colon Rectum 2000, 43:1487–1496.CrossRefGoogle Scholar
  15. 15.
    Young-Fadok TM, Sgambati SA, Nelson H: Post-operative benefits of laparoscopic resection for Crohn’s disease: a case-matched series. Surg Endosc 1999, 13(suppl):S90.Google Scholar
  16. 16.
    Bemelman WA, Slors JF, Dunker MS, et al.: Laparoscopic-assisted vs open ileocolic resection for Crohn’s disease. a comparative study. Surg Endosc 2000, 14:721–725.PubMedCrossRefGoogle Scholar
  17. 17.
    Wong KWW, Yacyshyn BR: Fulminant ulcerative colitis. Curr Treat Option Gastroenterol 2000, 3:217–226.CrossRefGoogle Scholar
  18. 18.
    Engelsgjerd M, Farraye FA, Odze RD: Polpectomy may be adequate treatment for adenoma-like dysplastic lesions in chronic ulcerative colitis. Gastroenterology 1999, 117:1288–1294.PubMedCrossRefGoogle Scholar
  19. 19.
    Rubin PH, Friedman S, Harpaz N, Goldstein E, Weiser J, Schiller J, Waye JD, Present DH: Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps. Gastroenterology 1999, 117:1295–1300.PubMedCrossRefGoogle Scholar
  20. 20.
    FaroukR, Pemberton JH, Wolff BG, et al.: Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 2000, 231:919–926. Largest experience with IPAA discussing functional results and complications.PubMedCrossRefGoogle Scholar
  21. 21.
    Tan HT AB, Connolly D, Morton M, Keighley RB: Results of restorative proctocolectomy in the elderly. Int J Colorect Dis 1997, 12:319–322.CrossRefGoogle Scholar
  22. 22.
    Prudhomme M, Farouk R, Dozois RR: Complications after ileal pouch-anal canal anastomosis. Perspect Colon Rectal Surg 1999, 11:57–68.Google Scholar
  23. 23.
    Farouk R, Dozois RR, Pemberton JH, Larson D: Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 1998, 41:1239–1243.PubMedCrossRefGoogle Scholar
  24. 24.
    Burakoff R: Crohn’s disease of the small intestine. Curr Treat Opt Gastroenterol 2000, 3:58–68.Google Scholar
  25. 25.
    Present DH, Rutgeerts P, Targan S, et al.: Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 1999, 340:1398–405.PubMedCrossRefGoogle Scholar
  26. 26.
    Heimann T, Greenstein AJ, Lewis B, et al.: Comparison of primary and reoperative surgery in patients with Crohn’s disease. Ann Surg 1998, 227:492–495.PubMedCrossRefGoogle Scholar
  27. 27.
    Hurst RD, Michelassi F: Strictureplasty for Crohn’s disease: techniques and long-terms results. World J Surg 1998, 22:359–363.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Robert R. Cima
    • 1
  • John H. Pemberton
  1. 1.Division of Colon and Rectal SurgeryThe Mayo ClinicRochesterUSA

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