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Perioperative optimization of Crohn's disease
Chun-Chi Lin1,2, Hung-Hsin Lin1,2, Hui-Chuen Chen3
1Division of Colon & Rectal Surgery, Department of Surgery Taipei Veterans General Hospital Taipei Taiwan.
Annals of Gastroenterological Surgery
|January 16, 2023
Summary
Managing Crohn's disease (CD) surgery involves optimizing nutrition and ERAS protocols. While corticosteroids increase surgical risk, biologics have low certainty of association, necessitating individualized preoperative medication decisions.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Clinical Pharmacology
Background:
- Crohn's disease (CD) is a chronic gastrointestinal inflammatory condition.
- While medical therapy is primary, many CD patients require surgery due to complications.
- Advancements in treatment modalities have improved CD management over the past two decades.
Purpose of the Study:
- To review the perioperative management of Crohn's disease patients undergoing surgery.
- To evaluate the impact of various medications on surgical risk in CD patients.
- To emphasize individualized, multidisciplinary decision-making for perioperative care.
Main Methods:
- Literature review of recent advancements in CD treatment and surgical management.
- Analysis of associations between preoperative medications (corticosteroids, immunomodulators, biologics) and surgical risk.
- Discussion of the role of nutritional optimization and Enhanced Recovery After Surgery (ERAS) protocols.
Main Results:
- Nutritional optimization and ERAS implementation are crucial for reducing postoperative complications in CD surgery.
- Corticosteroid use is associated with increased surgical risk.
- The association of surgical risk with immunomodulators and biologic therapies (anti-TNF, anti-integrin, anti-IL 12/23) has low certainty.
- Preoperative imaging aids surgical planning.
Conclusions:
- Perioperative medication decisions for Crohn's disease patients must be individualized.
- A multidisciplinary approach is essential for patient-centered surgical care.
- Patients require clear communication regarding treatment alterations during the perioperative period.
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