Recent advance in surgical management for Crohn's disease

The cause of Crohn's disease is still unknown and the disease is inherently refractory. Recently the number of cases with Crohn's disease has been increasing in our country, and we have begun to encounter the various complications associated with the disease. The purpose of surgical management for Crohn's disease is to maintain patient's quality of life as good condition by improving treatment of conplications such as bowel obstruction, intraabdominal abscess, internal or external fistula, and so on. Surgical indication is classified into absolute and relative one. Intestinal stenosis is a major complication of the disease. Minimal operative procedures, such as resection of a small part of the intestine or strictureplasty for skipped stenotic lesions of the small intestine, are ercommended. Laparoscopically assisted operations are applicable in selected patients. Selection of operative procedures is often difficult even for GI tract surgeons. We classified the operative findings of Crohn's lesions and developed a finding- based criteria to guide selection of the proper procedures. We recommended new strictureplasties, double Heineke-Mikulicz and side-to-side anastomosis (Michelassi), for multiple skipped lesions. Proper surgical procedures together with pre-and postoperative management lead to good results.