TY - JOUR
T1 - Surgical management of Crohn’s disease: a state of the art review
AU - Meima - van Praag, Elise Maria
AU - Buskens, Christianne Johanna
AU - Hompes, Roel
AU - Bemelman, Wilhelmus Adrianus
N1 - Publisher Copyright: © 2021, The Author(s).
PY - 2021/6
Y1 - 2021/6
N2 - Purpose: The aim of this review was to examine current surgical treatments in patients with Crohn’s disease (CD) and to discuss currently popular research questions. Methods: A literature search of MEDLINE (PubMed) was conducted using the following search terms: ‘Surgery’ and ‘Crohn’. Different current surgical treatment strategies are discussed based on disease location. Results: Several surgical options are possible in medically refractory or complex Crohn’s disease as a last resort therapy. Recent evidence indicated that surgery could also be a good alternative in terms of effectiveness, quality of life and costs as first-line therapy if biologicals are considered, e.g. ileocolic resection for limited disease, or as part of combination therapy with biologicals, e.g. surgery aiming at closure of select perianal fistula in combination with biologicals. The role of the mesentery in ileocolic disease and Crohn’s proctitis is an important surgical dilemma. In proctectomy, evidence is directing at removing the mesentery, and in ileocolic disease, it is still under investigation. Other surgical dilemmas are the role of the Kono-S anastomosis as a preventive measure for recurrent Crohn’s disease and the importance of (non)conventional stricturoplasties. Conclusion: Surgical management of Crohn’s disease remains challenging and is dependent on disease location and severity. Indication and timing of surgery should always be discussed in a multidisciplinary team. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease rather than being a last resort therapy.
AB - Purpose: The aim of this review was to examine current surgical treatments in patients with Crohn’s disease (CD) and to discuss currently popular research questions. Methods: A literature search of MEDLINE (PubMed) was conducted using the following search terms: ‘Surgery’ and ‘Crohn’. Different current surgical treatment strategies are discussed based on disease location. Results: Several surgical options are possible in medically refractory or complex Crohn’s disease as a last resort therapy. Recent evidence indicated that surgery could also be a good alternative in terms of effectiveness, quality of life and costs as first-line therapy if biologicals are considered, e.g. ileocolic resection for limited disease, or as part of combination therapy with biologicals, e.g. surgery aiming at closure of select perianal fistula in combination with biologicals. The role of the mesentery in ileocolic disease and Crohn’s proctitis is an important surgical dilemma. In proctectomy, evidence is directing at removing the mesentery, and in ileocolic disease, it is still under investigation. Other surgical dilemmas are the role of the Kono-S anastomosis as a preventive measure for recurrent Crohn’s disease and the importance of (non)conventional stricturoplasties. Conclusion: Surgical management of Crohn’s disease remains challenging and is dependent on disease location and severity. Indication and timing of surgery should always be discussed in a multidisciplinary team. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease rather than being a last resort therapy.
KW - Crohn’s disease
KW - Gastrointestinal tract
KW - Inflammatory bowel disease
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85100348943&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00384-021-03857-2
DO - https://doi.org/10.1007/s00384-021-03857-2
M3 - Review article
C2 - 33528750
SN - 0179-1958
VL - 36
SP - 1133
EP - 1145
JO - International journal of colorectal disease
JF - International journal of colorectal disease
IS - 6
ER -