Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2021; 13(1): 1-6
Published online Jan 27, 2021. doi: 10.4240/wjgs.v13.i1.1
Colonic Crohn’s disease – decision is more important than incision: A surgical dilemma
Maria Michela Chiarello, Maria Cariati, Giuseppe Brisinda
Maria Michela Chiarello, Maria Cariati, Department of Surgery, General Surgery Operative Unit, San Giovanni di Dio Hospital, Crotone 88900, Italy
Giuseppe Brisinda, Department of Medical and Surgical Sciences, Abdominal Surgery Clinical Area, Catholic School of Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Author contributions: Chiarello MM conceived the original idea; Chiarello MM and Cariati M performed a comprehensive review of all available literature, synthesized the data; Chiarello MM and Brisinda G wrote the manuscript; Chiarello MM and Brisinda G contributed to the study design, manuscript structure and performed a final critical appraisal of the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Brisinda, MD, Assistant Professor, Department of Medical and Surgical Sciences, Abdominal Surgery Clinical Area, Catholic School of Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Received: November 12, 2020
Peer-review started: November 12, 2020
First decision: November 29, 2020
Revised: December 4, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: January 27, 2021
Abstract

The most common localization for intestinal Crohn’s disease (CD) is the terminal ileum and ileocecal area. It is estimated that patients with CD have one in four chance of undergoing surgery during their life. As surgery in ulcerative colitis ultimately cures the disease, in CD, regardless of the extent of bowel removed, the risk of disease recurrence is as high as 40%. In elective surgery, management of isolated Crohn’s colitis continues to evolve. Depending on the type of surgery performed, colonic CD patients often require further medical or surgical therapy to prevent or treat recurrence. The elective surgical treatment of colonic CD is strictly dependent on the localization of disease, and the choice of the procedure is dependent of the extent of colonic involvement and previous resection. The most common surgical options in colonic CD are total proctocolectomy (TPC) with permanent ileostomy, segmental bowel resection, subtotal colectomy. TPC completely removes all colonic and rectal disease and avoids the use of a potentially diseased anus. We will review current options for the elective surgical treatment of colonic CD, based on the current literature and our own personal experience.

Keywords: Crohn’s disease, Colonic Crohn’s disease, Surgery, Surgical treatment, Colonic resection, Segmental colectomy, Total colectomy

Core Tip: The most common localization for intestinal Crohn’s disease (CD) is the terminal ileum and ileocecal area. In elective surgery, management of isolated Crohn’s colitis continues to evolve. As surgery in ulcerative colitis ultimately cures the disease, in CD, regardless of the extent of bowel removed, the risk of disease recurrence is as high as 40%. Depending on the type of surgery performed, colonic CD patients often require further medical or surgical therapy to prevent or treat recurrence. The elective surgical treatment of colonic CD is strictly dependent on the localization of disease, and the choice of the procedure is dependent of the extent of colonic involvement and previous resection.