[Surgical therapy of complicated inflammatory bowel disease]

The etiology of chronic inflammatoric bowel disease is unknown, conservative treatment will be reduced to the management of immunologic and inflammatoric reaction. The large majority of patients affected with Crohn's disease and also nearly 50% of patients with ulcerous colitis require surgery during their clinical history. The indication for surgery is a balance between the severity and the complications of the disease and the potential disadvantages of surgery. For surgical therapy the differentiation of Crohn's disease and ulcerous colitis is essential because of the differentiated character of both diseases. In Crohn's disease surgical therapy will be performed by the management of Crohn's specific complications like stenosis, fistula, and abscess by bowel preserveration. Limited resection and/or strictureplasty do not influence morbidity and rate and also time of recurrence. Ulcerous colitis can be cured when the colorectal mucosa will be removed totally by radical surgery, i.e. restorative proctocolectomy. The satisfactory outcome in 70 to 90% of patients with a cumulative failure rate of 10 to 15% over a 10-year-period improves the quality of life.