[Surgical management of inflammatory bowel diseases]

Abstract

The development of the medical management of the inflammatory bowel disease (IBD-ulcerative colitis, Crohn's disease) has reduced the number of the acute surgical interventions. Beyond the medical treatment the surgical management, the operative modalities, the pre and postoperative care has gone through a lot of changes. They review the different types of surgical alternatives and debating on the advantages and disadvantages, they put emphasis on the different surgical solutions of the Crohn's disease and that of the ulcerative colitis. Among the applied surgical alternatives to the ulcerative colitis they discuss the traditional proctocolectomy with end-ileostomy, the Kock-reservoir (as continent stoma), as well as the restorative proctocolectomy which is sufficient to preserve the anal continence. Principles of the surgery of the Crohn's disease are discussed according to the localisation of the inflammatory process (small bowel, colonic, rectal, anal channel). Because of the predisposition of relapses and the necessity of the successive surgical therapy, the extensive resections should be avoided.