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Review
. 2021 Jun;36(6):1133-1145.
doi: 10.1007/s00384-021-03857-2. Epub 2021 Feb 2.

Surgical management of Crohn's disease: a state of the art review

Elise Maria Meima-van Praag  1 , Christianne Johanna Buskens  2 , Roel Hompes  2 , Wilhelmus Adrianus Bemelman  2
Affiliations
Review

Surgical management of Crohn's disease: a state of the art review

Elise Maria Meima-van Praag et al. Int J Colorectal Dis. 2021 Jun.

Abstract

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.

Keywords: Crohn’s disease; Gastrointestinal tract; Inflammatory bowel disease; Surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for Crohn’s ileocolic treatment strategy
Fig. 2
Fig. 2
Markedly thickened (neo)terminal ileum with stenosis. Coronal T2-weighted post-contrast image of a patient with status after ileocaecal resection. MRI shows concentric wall thickening at the neoterminal ileum over a length of about 8 cm
Fig. 3
Fig. 3
Extended mesenterectomy
Fig. 4
Fig. 4
Close bowel ileocaecal resection
Fig. 5
Fig. 5
Complex perianal fistula with clear internal orfice (arrow). Coronal T2-weighted post-contrast MRI
See this image and copyright information in PMC

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