Surgical Considerations in the Treatment of Small Bowel Crohn's Disease.

Published

Journal Article (Review)

Surgery remains a cornerstone of the management of Crohn's disease (CD). Despite the rise of biologic therapy, most CD patients require surgery for penetrating, obstructing, or malignant complications. Optimal surgical therapy requires sophisticated operative judgment and medical optimization. Intraoperatively, surgeons must balance treatment of CD complications against bowel preservation and functional outcome. This demands mastery of multiple techniques for anastomosis and strictureplasty, accurate assessment of bowel integrity for margin minimization, and a comprehensive skillset for navigating adhesions and altered anatomy, controlling thickened mesentery, and safely managing the hostile abdomen. Outside of the operating room, a multi-disciplinary team is critical for pre-operative optimization, patient support, and medical management. Postoperatively, prevention and surveillance of recurrence remain a matter of research and debate, and medical options include older drugs with limited efficacy and tolerability versus biologic agents with greater effect sizes and shorter track records. The evidence base for current management is limited by the inherent challenges of studying a chronic disease marked by heterogeneity and recurrence, but also by a lack of prospective trials incorporating both medical and surgical therapies.

Full Text

Duke Authors

Cited Authors

  • Maguire, LH; Alavi, K; Sudan, R; Wise, PE; Kaiser, AM; Bordeianou, L

Published Date

  • February 2017

Published In

Volume / Issue

  • 21 / 2

Start / End Page

  • 398 - 411

PubMed ID

  • 27966058

Pubmed Central ID

  • 27966058

Electronic International Standard Serial Number (EISSN)

  • 1873-4626

Digital Object Identifier (DOI)

  • 10.1007/s11605-016-3330-9

Language

  • eng

Conference Location

  • United States