Surgery for Crohn’s disease: upfront or last resort?

Abstract

Crohn’s disease (CD) can involve the entire gastrointestinal tract from the mouth to the anus and can lead to a constellation of symptoms. With the advancement of effective medical treatments for CD, a tendency has emerged to consider surgical treatment as a last resort. This potentially has the disadvantage of delaying surgery and if it fails might leave patients sicker, less well nourished, and with more severe complications. As with most non-malignant diseases, the choice of surgery vs medical treatment is a patient’s personal preference under the guidance of the treating physician, except in extreme situations where surgery might be the only option. In this article, we will discuss the available evidence regarding the optimal timing of surgery in CD, focusing on whether early surgery can bring benefits in terms of disease control, symptom relief, and quality of life.

The Enigma of Crohn’s Disease: A Case Report

“…Common indications for surgery include disease refractory to medical therapy, uncontrollable bleeding, obstructive strictures, fistulizing disease, bowel perforation, and suspected malignancy [ 10 ]. Surgery should be considered earlier in the treatment course for patients with recalcitrant CD, rather than viewing surgery as a failure of medical management [ 11 ]. Emergency surgery should be avoided whenever possible due to its associated morbidities and a higher rate of stoma formation.…”

Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review

“…In the pre-biological era, a significant proportion of patients with IBD required intestinal surgery within 10 years of diagnosis, with high rates of recurrence[ 3 , 58 ]. However, the introduction of biological therapies has led to a decline in the surgery rate[ 3 , 58 ]. Nonetheless, a considerable number of CD and UC patients still require surgery within 1 year[ 2 , 3 , 58 ].…”

“…However, the introduction of biological therapies has led to a decline in the surgery rate[ 3 , 58 ]. Nonetheless, a considerable number of CD and UC patients still require surgery within 1 year[ 2 , 3 , 58 ]. The choice of surgical approach depends on the patient’s condition and disease severity[ 3 , 58 ].…”

“…IBD can cause debilitating physical and psychosocial symptoms, resulting in a significant economic burden associated with diagnosis, follow-up, and treatment[ 3 ]. Medical therapies, including 5-aminosalicylates (5-ASA), steroids, immunomodulators, small molecules, and biologics, aim to alleviate symptoms and achieve mucosal healing based on disease severity.…”

Preoperative Optimization of Crohn's Patients before Abdominopelvic Surgery

“…74 CD patients with stenotic or fibrotic disease may be offered surgery as the firstline treatment to avoid delays. 75 Surgery is also recommended among patients with ileocecal CD who have failed or relapsed after standard medical therapy. 76 In addition, the "LIR!C" trial highlighted laparoscopic ICR as a first-line treatment option for terminal ileitis among patients with CD.…”