Skip to main content
Journal cover image

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

Publication ,  Journal Article
Maguire, LH; Alavi, K; Sudan, R; Wise, PE; Kaiser, AM; Bordeianou, L
Published in: J Gastrointest Surg
February 2017

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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

February 2017

Volume

21

Issue

2

Start / End Page

398 / 411

Location

Netherlands

Related Subject Headings

  • Surgery
  • Patient Selection
  • Intestine, Small
  • Humans
  • Crohn Disease
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Maguire, L. H., Alavi, K., Sudan, R., Wise, P. E., Kaiser, A. M., & Bordeianou, L. (2017). Surgical Considerations in the Treatment of Small Bowel Crohn's Disease. J Gastrointest Surg, 21(2), 398–411. https://doi.org/10.1007/s11605-016-3330-9
Maguire, Lillias Holmes, Karim Alavi, Ranjan Sudan, Paul E. Wise, Andreas M. Kaiser, and Liliana Bordeianou. “Surgical Considerations in the Treatment of Small Bowel Crohn's Disease.J Gastrointest Surg 21, no. 2 (February 2017): 398–411. https://doi.org/10.1007/s11605-016-3330-9.
Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM, Bordeianou L. Surgical Considerations in the Treatment of Small Bowel Crohn's Disease. J Gastrointest Surg. 2017 Feb;21(2):398–411.
Maguire, Lillias Holmes, et al. “Surgical Considerations in the Treatment of Small Bowel Crohn's Disease.J Gastrointest Surg, vol. 21, no. 2, Feb. 2017, pp. 398–411. Pubmed, doi:10.1007/s11605-016-3330-9.
Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM, Bordeianou L. Surgical Considerations in the Treatment of Small Bowel Crohn's Disease. J Gastrointest Surg. 2017 Feb;21(2):398–411.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

February 2017

Volume

21

Issue

2

Start / End Page

398 / 411

Location

Netherlands

Related Subject Headings

  • Surgery
  • Patient Selection
  • Intestine, Small
  • Humans
  • Crohn Disease
  • 3202 Clinical sciences
  • 1103 Clinical Sciences