TY - JOUR
T1 - Surgical Considerations in the Treatment of Small Bowel Crohn’s Disease
AU - Maguire, Lillias Holmes
AU - Alavi, Karim
AU - Sudan, Ranjan
AU - Wise, Paul E.
AU - Kaiser, Andreas M.
AU - Bordeianou, Liliana
N1 - Publisher Copyright:
© 2016, The Society for Surgery of the Alimentary Tract.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - 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.
AB - 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.
KW - Crohn’s disease
KW - Small bowel
KW - Stricturoplasty
UR - http://www.scopus.com/inward/record.url?scp=85003845728&partnerID=8YFLogxK
U2 - 10.1007/s11605-016-3330-9
DO - 10.1007/s11605-016-3330-9
M3 - Article
C2 - 27966058
AN - SCOPUS:85003845728
SN - 1091-255X
VL - 21
SP - 398
EP - 411
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 2
ER -