title: Indications and Specific Surgical Techniques in Crohn's Disease.
abstract: BACKGROUND
  Crohn's disease (CD) as one of the major entities of chronic inflammatory bowel diseases can affect all segments of the gastrointestinal tract but occurs most often in the small bowel, the terminal ileum, the colon, and the rectum. Typical symptoms include tiredness, lower abdominal pain, fever, and diarrhea, which are initially treated by conservative measures. Most patients will eventually develop complications such as fistulas, abscesses, or strictures. Surgery is often unavoidable in these cases.
  
  
  METHODS
  This review considers studies on the treatment of CD, published from 1979 up to now. The literature regarding the course, complications, and surgical therapy of CD was reviewed. Searches were performed in PubMed, using the following key words: CD, surgery, immunosuppression, guidelines, malnutrition as well as appropriate sub-items. In most cases the literature is limited to detailed information on specific therapeutic or diagnostic topics. Moreover, many studies are designed retrospectively and with a small number of patients. Additionally, our long-standing experience with patients suffering from CD is taken into consideration in this review.
  
  
  RESULTS
  There is a wide variety of indications for surgery in CD which includes complications like strictures, fistulas and abscess formation, neoplasia, or refractoriness to medical therapy. The risk of developing complications is about 33% after 5 years, and 50% after 20 years. Furthermore, one-third of CD patients need surgical therapy within the ﬁrst 5 years of diagnosis. The treatment requires close cooperation between gastroenterologists and surgeons. When indicated, surgery should be performed in a 'conservative' fashion, i.e. as limited as possible, in order to achieve the required result and to avoid small bowel syndrome.
  
  
  CONCLUSIONS
  This article provides a complete overview of indications and specific surgical treatment in patients with CD. Surgery is typically indicated when complications of CD occur. An interdisciplinary collaboration is necessary in order to ensure optimal indications and timing of surgery. This is of paramount importance to achieve the ultimate goal, i.e. a good quality of life of the patients.
authors.affiliation: Department of General, Visceral- and Vascular Surgery, Charité - University Medicine, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Seifarth
authors.affiliation: Department of General, Visceral- and Vascular Surgery, Charité - University Medicine, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Kreis
authors.affiliation: Department of General, Visceral- and Vascular Surgery, Charité - University Medicine, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Gröne
keywords: Crohn's Disease; Immunosuppression; Risk assessment; Surgery