title: [Refractory inflammatory bowel disease: surgical challenges].
abstract: Surgery for inflammatory bowel disease under immunosuppressant drugs is a widely discussed topic. Because therapeutic concepts have significantly changed, almost no patient is currently without an immunosuppressant or biologic agent prior to surgery. However, the data whether biological agents and immunosuppressant are a risk factor are very inconsistent. Concerning Crohn's disease, monotherapy with immunosuppressants or biological agents seems to have no negative influence on the postoperative results. In contrast, however, for ulcerative colitis more publications recognise biologic agents and immunosuppressants as a single therapy as a risk factor for infections. To reduce the general risk, all risk factors have to be reduced. In Crohn's disease, nutritional status must be optimised, corticoids should be reduced, biological agents and immunosuppressant drugs should be stopped, protection of an eventual anastomosis by a stoma. For ulcerative colitis in high-risk patients, a three-stage restaurative proctocolectomy is favoured to a one- or two-staged proctocolectomy.
authors.affiliation: Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V., Haus der Bundespressekonferenz, Schiffbauerdamm 40, 10117, Berlin, Deutschland, hbuhr@dgav.de.
authors.forename: H J
authors.initials: HJ
authors.lastname: Buhr
authors.forename: A J
authors.initials: AJ
authors.lastname: Kroesen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D009752:Nutritional Status; D009894:Opportunistic Infections / Q000139:chemically induced / Q000401:mortality; D011183:Postoperative Complications / Q000139:chemically induced* / Q000401:mortality; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000139:chemically induced / Q000401:mortality; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha