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Surgery in Crohn’s disease

Crohn’s disease can involve the whole GIT and hence is not curable by surgery (unlike UC).   Surgery is needed if medical management has failed.
Discuss surgery in CD?

  • Intra abdominal abscess- an established abscess should be drained by percutaneous route, if possible. If this is unsuccessful, surgical drainage may be needed.
  • Fistulas- the diseased segment of the bowel is resected and re-anastomosed. Subsequently the fistula to adjacent organs (bowel, vagina, bladder etc) is closed by suturing the site of entrance.  The adjacent organ may need resection too, if involved by Crohn’s disease. Management of perianal fistula depend on their anatomy (see the perianal CD section)
  • Strictures- options are resection or stricturoplasty. Stricturoplasty essentially means creation of a longitudinal section through the stricture and then closing it transversely. Stricturoplasty is preferred in patients at risk of short bowel syndrome from previous resections. The risk of recurrent stricture formation with stricturoplasty is low and is comparable to resection. Stricturoplasty should not be performed in acutely inflamed bowel.
  • Endoscopic balloon dilatation of ileocolonic strictures may be considered in selected cases in which it is considered desirable to postpone surgery. Experience with balloon dilatation is limited but there is a significant risk of perforation.
  • Colonic disease- segmental colectomy may be sufficient for isolated areas of colonic involvement. Total proctocolectomy may be needed for extensive disease. Colectomy and ileorectal anastomosis may be done if the rectum is not involved. Colectomy and ileorectal anastomosis may also be needed if two or more colonic segments are involved.
  • A meta-analysis showed that side to side anastomosis after ileocolonic resection was associated with fewer anastomotic leaks and postoperative complications and also a lower peri-anastomotic recurrence rates compared to end to end anastomosis

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