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Surgical Management of Stricturing Crohn’s Disease

Alex Tzivanakis MB, BS, BSc, MRCS, and Bruce George, MB, MS, BSc, FRCS

About one-third of patients with Crohn’s disease will develop stricturing disease, most of whom will require surgery during their lifetime. Indications and timing of surgery have been changing in recent years with the increased use of biological agents and endoscopic balloon dilatation. Pre-operative management involves thorough patient assessment and correction of factors that increase the risks of surgery such as high-dose steroids, malnutrition, and intra-abdominal abscess. Operative management aims to alleviate strictures either by resection or strictureplasty, adhering to the principles of preservation of bowel length and safe anastomoses. A meta-analysis of laparoscopic surgery for Crohn’s disease suggests improved short-term outcomes including lower complication rates. Laparoscopic surgery is feasible for the majority of “first-time” Crohn’s operations and selected “re-do” operations. Postoperative care aims to reduce the risk of recurrent Crohn’s disease. Avoiding smoking is important, while the role of drug prophylaxis is the subject of several ongoing randomized trials. This article provides an overview of surgical management of stricturing Crohn’s disease. Inflamm Bowel Dis Monit 2011;11(4):145–51.

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May 24, 2012

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