Inflammatory bowel disease revisited: surgery today and tomorrow

Both topical and systemic medical therapy are helpful in controlling the symptoms in patients with ulcerative colitis. However, no drug therapy is known to influence the natural history of Crohn's disease. Surgical management is often required for the complications of acute colitis unresponsive to medical treatment and for socially incapacitating diarrhoea and urgency due to ulcerative colitis. The gold standard of such surgical treatment is a panproctocolectomy with end ileostomy. In young patients with a good anal sphincter, total colectomy with the formation of an ileal pouch-to-anus anastomosis obliterates the disease and usually results in satisfactory continence. There appears to be no prospect of using gut transplantation in the management of this disease. In the absence of curative medical treatment for Crohn's disease surgical intervention is often needed to control the complications of Crohn's disease. The initial complication that makes the disease symptomatic is stenosis from the healing of asymptomatic ulcers. If strictures can be detected early, they can be treated before secondary complications such as abscess or fistula occur. Some success is being achieved with balloon dilatation of strictures. For the first presentation of ileo-caecal Crohn's disease limited resection offers good long-term cure without the need for continued medical therapy. For recurrent and multiple strictures strictureplasty offers a safe alternative to extensive resection.