Surgery for luminal Crohn’s disease

Abstract

Many patients with Crohn’s disease (CD) require surgery. Indications for surgery include failure of medical treatment, bowel obstruction, fistula or abscess formation. The most common surgical procedure is resection. In jejunoileal CD, strictureplasty is an accepted surgical technique that relieves the obstructive symptoms, while preserving intestinal length and avoiding the development of short bowel syndrome. However, the role of strictureplasty in duodenal and colonic diseases remains controversial. In extensive colitis, after total colectomy with ileorectal anastomosis (IRA), the recurrence rates and functional outcomes are reasonable. For patients with extensive colitis and rectal involvement, total colectomy and end-ileostomy is safe and effective; however, a few patients can have subsequent IRA, and half of the patients will require proctectomy later. Proctocolectomy is associated with a high incidence of delayed perineal wound healing, but it carries a low recurrence rate. Patients undergoing proctocolectomy with ileal pouch-anal anastomosis had poor functional outcomes and high failure rates. Laparoscopic surgery has been introduced as a minimal invasive procedure. Patients who undergo laparoscopic surgery have a more rapid recovery of bowel function and a shorter hospital stay. The morbidity also is lower, and the rate of disease recurrence is similar compared with open procedures.

Keywords: Crohn’s disease; Laparoscopic surgery; Resection; Strictureplasty; Surgery

Core tip: Strictureplasty is now an accepted procedure in the management of jejunoileal Crohn’s disease (CD). However, the place for strictureplasty is less well defined in duodenal and colonic diseases. For patients with extensive colonic CD, the surgical choices include total colectomy with either an ileorectal anastomosis or end-ileostomy, or a total proctocolectomy with permanent end-ileostomy. Patients with CD undergoing ileal pouch-anal anastomosis are associated with poor functional outcomes and high failure rates. Laparoscopic surgery is safe and feasible. Patients who undergo laparoscopic surgery have a more rapid recovery of bowel function and a shorter hospital stay.