title: Surgery for luminal Crohn's disease.
abstract: Many patients with Crohn's disease (CD) require surgery. Indications for surgery include failure of medical treatment, bowel obstruction, fistula or abscess formation. The most common surgical procedure is resection. In jejunoileal CD, strictureplasty is an accepted surgical technique that relieves the obstructive symptoms, while preserving intestinal length and avoiding the development of short bowel syndrome. However, the role of strictureplasty in duodenal and colonic diseases remains controversial. In extensive colitis, after total colectomy with ileorectal anastomosis (IRA), the recurrence rates and functional outcomes are reasonable. For patients with extensive colitis and rectal involvement, total colectomy and end-ileostomy is safe and effective; however, a few patients can have subsequent IRA, and half of the patients will require proctectomy later. Proctocolectomy is associated with a high incidence of delayed perineal wound healing, but it carries a low recurrence rate. Patients undergoing proctocolectomy with ileal pouch-anal anastomosis had poor functional outcomes and high failure rates. Laparoscopic surgery has been introduced as a minimal invasive procedure. Patients who undergo laparoscopic surgery have a more rapid recovery of bowel function and a shorter hospital stay. The morbidity also is lower, and the rate of disease recurrence is similar compared with open procedures.
authors.affiliation: Takayuki Yamamoto, Inflammatory Bowel Disease Center and Department of Surgery, Yokkaichi Social Insurance Hospital, Mie 510-0016, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Takayuki Yamamoto, Inflammatory Bowel Disease Center and Department of Surgery, Yokkaichi Social Insurance Hospital, Mie 510-0016, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000818:Animals; D003424:Crohn Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007422:Intestines / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Crohn’s disease; Laparoscopic surgery; Resection; Strictureplasty; Surgery