Surgery for Crohn's colitis

The majority of patients with Crohn's colitis eventually require surgical excision of the disease. The decision as to which operation to perform depends on the extent and site of disease, distensibility of the rectum, the presence of perianal disease, the age and attitude of the patients and their acceptance or otherwise of a stoma. Total proctocolectomy and ileostomy gave the best long-term results for Crohn's colitis in terms of recurrence rate. Abdominal colectomy and ileorectal anastomosis often restores young patients to good health without the risk of impaired sexual function from pelvic dissection and a permanent stoma is delayed and sometimes avoided. Segmental colonic resection should be considered for isolated short segment of Crohn's colitis but the optimal timing of such a procedure is not clear.