Surgical management

Around 50% - 80% of Crohn’s disease patients will need surgical intervention at some stage of the disease (1).
Majority of patients undergo surgery due to:

• strictures causing obstructive symptoms
• lack of response to medical therapy,
• complications such as fistulae and perianal disease (1)

Surgical intervention is limited in Crohn's disease because:

• the whole alimentary tract may be affected from mouth to anus
• the disease is often active at more than one site

Consequently, there is a high incidence of postoperative complications following surgery, and a concept of minimal surgical intervention has thus been reached.

Laparoscopic resection is becoming the preferred method of choice (especially for ileocaecal resection) due to the shorter hospital stay and lower post-operative morbidity (1).

NICE have stated that surgery in Crohn's disease may be indicated if the disease is limited to the distal ileum. Also balloon dilatation may be indicated (2)

• Crohn's disease limited to the distal ileum
  
  
  • surgery as an alternative to medical treatment
    • consider surgery as an alternative to medical treatment early in the course of the disease for people whose disease is limited to the distal ileum, taking into account the following:
      • benefits and risks of medical treatment and surgery
      • risk of recurrence after surgery
      • individual preferences and any personal or cultural considerations
        
        
  • surgery early in the disease
    • consider surgery early in the course of the disease or before or early in puberty for children and young people whose disease is limited to the distal ileum and who have:
      • growth impairment despite optimal medical treatmentand/or
      • refractory disease
        
        
• balloon dilation
  • consider balloon dilation particularly in people with a single stricture that is short, straight and accessible by colonoscopy.

Reference:

• (1) National Institute for Health and Clinical Excellence (NICE) 2010. Infliximab (review) and adalimumab for the treatment of Crohn’s disease
• (2) NICE (May 2019). Crohn's disease Management in adults, children and young people