title: Surgical Considerations in the Treatment of Small Bowel Crohn's Disease.
abstract: Surgery remains a cornerstone of the management of Crohn's disease (CD). Despite the rise of biologic therapy, most CD patients require surgery for penetrating, obstructing, or malignant complications. Optimal surgical therapy requires sophisticated operative judgment and medical optimization. Intraoperatively, surgeons must balance treatment of CD complications against bowel preservation and functional outcome. This demands mastery of multiple techniques for anastomosis and strictureplasty, accurate assessment of bowel integrity for margin minimization, and a comprehensive skillset for navigating adhesions and altered anatomy, controlling thickened mesentery, and safely managing the hostile abdomen. Outside of the operating room, a multi-disciplinary team is critical for pre-operative optimization, patient support, and medical management. Postoperatively, prevention and surveillance of recurrence remain a matter of research and debate, and medical options include older drugs with limited efficacy and tolerability versus biologic agents with greater effect sizes and shorter track records. The evidence base for current management is limited by the inherent challenges of studying a chronic disease marked by heterogeneity and recurrence, but also by a lack of prospective trials incorporating both medical and surgical therapies.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 15 Parkman St, Boston, MA, 617-02114, USA.|Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Lillias Holmes
authors.initials: LH
authors.lastname: Maguire
authors.affiliation: Department of Surgery, UMass Memorial Medical Center, Worcester, MA, USA.
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sudan
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wise
authors.affiliation: Department of Colorectal Surgery, University of Southern California, Los Angeles, CA, USA.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Kaiser
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 15 Parkman St, Boston, MA, 617-02114, USA. lbordeianou@mgh.harvard.edu.
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
mesh_terms: D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007421:Intestine, Small; D018579:Patient Selection
keywords: Crohn’s disease; Small bowel; Stricturoplasty