Surgical management in intestinal Crohn's disease

Yuji Funayama, Ken Ichi Takahashi, Iwao Sasaki

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

The main strategy in surgical treatment of Crohn's disease is resection of the diseased segment, despite possible development of postoperative nutritional impairment and lowered quality of life (QOL) caused by short bowel syndrome and early postoperative relapse. To overcome postoperative short bowel syndrome, minimal resection is highly recommended, and furthermore strictureplasty is now used in many institutions. Many reports have shown that strictureplasty is safe, has a low rate of surgical complications, and displays identical surgical results as intestinal resection. To apply this procedure to various types of Crohn's disease, different derivatives of this procedure, such as Heineke-Mikulicz, Finney, Jaboulay, and double Heineke-Mikulicz type, as well as side-to-side isoperistaltic strictureplasty have evolved. In performing strictureplasty, the severity of stenosis is more important than the length of the stricture, because a simple but long stricture can be easily managed by any method of this procedure. Further, it is necessary to investigate the surgical specimens via histopathological analysis of frozen section when neoplastic change is suspected. Now, functional end-to-end anastomosis using a linear stapler has become the most frequently used method in intestinal surgery. Many studies have documented less leakage, morbidity, and anastomotic recurrence as well as shorter hospital stay following stapled anastomosis. As part of the postoperative maintenance treatment regimen, various drugs, such as masalamine, immunomodulators, and infliximab, have been shown to demonstrate positive efficacy when used solely or in combination. Endoscopic examination should be done regularly, and the maintenance treatment regimen should be adjusted according to the disease activity.

Original languageEnglish
Pages (from-to)1-5
Number of pages5
JournalClinical Journal of Gastroenterology
Volume3
Issue number1
DOIs
Publication statusPublished - 2010 Feb

Keywords

  • Crohn's disease
  • Postoperative maintenance treatment
  • Strictureplasty
  • Surgery

ASJC Scopus subject areas

  • Gastroenterology

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