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Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Despite advancements in medical therapy of Crohn’s disease (CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to redu...

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Autores principales: Toh, James WT, Stewart, Peter, Rickard, Matthew JFX, Leong, Rupert, Wang, Nelson, Young, Christopher J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083794/
https://www.ncbi.nlm.nih.gov/pubmed/27833380
http://dx.doi.org/10.3748/wjg.v22.i40.8892
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author Toh, James WT
Stewart, Peter
Rickard, Matthew JFX
Leong, Rupert
Wang, Nelson
Young, Christopher J
author_facet Toh, James WT
Stewart, Peter
Rickard, Matthew JFX
Leong, Rupert
Wang, Nelson
Young, Christopher J
author_sort Toh, James WT
collection PubMed
description Despite advancements in medical therapy of Crohn’s disease (CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD (and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.
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spelling pubmed-50837942016-11-10 Indications and surgical options for small bowel, large bowel and perianal Crohn's disease Toh, James WT Stewart, Peter Rickard, Matthew JFX Leong, Rupert Wang, Nelson Young, Christopher J World J Gastroenterol Review Despite advancements in medical therapy of Crohn’s disease (CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD (and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates. Baishideng Publishing Group Inc 2016-10-28 2016-10-28 /pmc/articles/PMC5083794/ /pubmed/27833380 http://dx.doi.org/10.3748/wjg.v22.i40.8892 Text en ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Review
Toh, James WT
Stewart, Peter
Rickard, Matthew JFX
Leong, Rupert
Wang, Nelson
Young, Christopher J
Indications and surgical options for small bowel, large bowel and perianal Crohn's disease
title Indications and surgical options for small bowel, large bowel and perianal Crohn's disease
title_full Indications and surgical options for small bowel, large bowel and perianal Crohn's disease
title_fullStr Indications and surgical options for small bowel, large bowel and perianal Crohn's disease
title_full_unstemmed Indications and surgical options for small bowel, large bowel and perianal Crohn's disease
title_short Indications and surgical options for small bowel, large bowel and perianal Crohn's disease
title_sort indications and surgical options for small bowel, large bowel and perianal crohn's disease
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083794/
https://www.ncbi.nlm.nih.gov/pubmed/27833380
http://dx.doi.org/10.3748/wjg.v22.i40.8892
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