Operative indications and options in intestinal Crohn's disease

Multidisciplinary management of Crohn's disease is mandated by the complexity of the clinical scenarios and interfaces between medical treatment, nutritional support, and surgical interventions. Surgery is a critical component of the treatment algorithm intended to improve patient symptoms and quality of life, resolve disease-associated complications, and maximize efficacy of medical therapy. The most common procedure performed for intestinal Crohn's disease is resection of the affected segment of bowel with primary anastomosis when feasible and indicated. Different surgical techniques have been proposed with the goals of limiting postoperative complications and preventing surgical recurrences. Selected patients affected by intestinal Crohn's disease are at especially increased risk for repeated surgical intervention and bowel sparing techniques have been developed to reduce the risk of short bowel syndrome in this population. The clinical scenarios of intestinal Crohn's disease vary as to when surgery is indicated and what techniques should be employed. Multiple surgical options might be used in a single patient with multifocal disease with an intent to provide a longer remission time. The important role of preoperative optimization and postoperative treatment reinforces the notion that timing and coordination of medical and surgical treatments is crucial in this debilitating and complex disease.