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Crohn’s disease: postsurgical
Abbreviations
CD
Crohn’s disease
EI
end ileostomy
IBD
inflammatory bowel disease
ICA
ileocolonic anastomosis
ICR
ileocolonic resection
IRA
ileorectal anastomosis
LI
loop ileostomy
RS
the Rutgeerts score
RVF
rectovaginal fistula
STX
strictureplasty
Introduction
Despite advances in medical therapy, approximately 70% of patients with Crohn’s disease (CD) would eventually require surgery . Various surgical modalities have been designed and performed for patients with medically or endoscopically refractory CD or inflammatory bowel disease (IBD)–associated neoplasia ( Table 8.1 ). Multiple factors contribute to the selection of proper surgical treatment modalities. Those factors include degree and severity of underlying CD, disease phenotype and location, general health conditions (especially nutrition, anemia, and immunosuppression), concurrent medical therapy, history of prior surgery, and local expertise.
Table 8.1
Surgical treatment modalities for Crohn’s disease.
| Examples | |
|---|---|
| Resection and anastomosis | Ileocolonic resection with ileocolonic anastomosis |
| Ileocolonic resection with ileorectal anastomosis | |
| Jejunal resection with jejunoileal anastomosis | |
| Strictureplasty | Heineke–Mikulicz |
| Finney | |
| Michelassi | |
| Stoma and fecal diversion | Loop or end ileostomy |
| End colostomy | |
| Jejunostomy | |
| Hartmann procedure with later completion proctectomy | |
| Mucus fistula | |
| Bypass | Duodenum disease with gastrojejunostomy |
| Surgical treatment of perianal disease | Incision and drainage |
| Seton and mushroom |
In this chapter the author discusses common surgical modalities, postsurgical anatomy, and monitoring disease recurrence in patients with CD. CD surgery-associated complications are discussed in a separate chapter ( Chapter 16 : Postoperative complications in Crohn’s disease).
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