Immunomodulators: Friends or Enemies in Surgery for Crohn's Disease?

Crohn's disease may severely impact the quality of life and being a chronic disease it requires both medical and surgical treatment aimed at induction and maintenance of remission to prevent relapsing symptoms and the need for further surgery. Surgery in Crohn's disease often has to be performed in patients with well-known risk factors of post-operative complications, particularly intraabdominal septic complications. This review will look at the current knowledge of immunomodulating therapies in the peri-operative phase of Crohn's disease. The influence of immunomodulators on postoperative complications is evaluated by reviewing available clinical reports and data from animal studies. Furthermore, the effect of immunomodulators on preventing or deferring primary as well as repeat surgery in Crohn's disease is reviewed with particular consideration given to high-risk cohorts and timing of prophylaxis.