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Controversies in Crohn's disease

J J Murray1

  • 1Department of Colon and Rectal Surgery, Lahey Hitchcock Medical Center, Burlington, MA 01805, USA.

Bailliere'S Clinical Gastroenterology
|August 15, 1998
PubMed
Summary
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Surgery remains crucial for Crohn's disease management, with evolving strategies addressing complications. This review covers controversial surgical interventions like strictureplasty, sphincter-saving resections, and anal fistula repair for improved patient outcomes.

Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Inflammatory Bowel Disease

Background:

  • Medical therapies for Crohn's disease have advanced, yet surgical intervention remains a cornerstone.
  • The surgical management strategies for Crohn's disease are continuously evolving.
  • Understanding the natural history and refining surgical techniques are key to optimizing treatment.

Purpose of the Study:

  • To review controversial aspects of surgical palliation for Crohn's disease complications.
  • To discuss current evidence and indications for various surgical procedures.
  • To evaluate factors influencing outcomes in complex Crohn's disease cases.

Main Methods:

  • Review of current literature and surgical experience.
  • Analysis of indications for specific surgical procedures.

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  • Critical evaluation of outcomes for different surgical interventions.

    • Main Results:

    • Strictureplasty is indicated for intractable intestinal obstruction in Crohn's disease.
    • Sphincter-saving resections impact long-term outcomes in Crohn's colitis.
    • Definitive treatment for anal Crohn's disease and rectovaginal fistulas is examined.
    • Ileocolic resection is considered for acute Crohn's ileitis during laparotomy.

    Conclusions:

    • Surgical treatment of Crohn's disease involves several controversial areas.
    • Improved understanding of disease natural history and refined surgical techniques guide interventions.
    • Clearer criteria for surgical intervention enhance patient outcomes.