The surgical intervention: earlier or never?

Best Pract Res Clin Gastroenterol. 2014 Jun;28(3):497-503. doi: 10.1016/j.bpg.2014.04.013. Epub 2014 May 10.

Abstract

Crohn's disease (CD) is a chronic and progressive disease characterized by the presence of inflammation in different segments of the digestive tract, resulting in damages of the entire wall. Untreated or treated inappropriately, this eventually might result in stricturing and/or penetrating complications. Traditionally, the first line of treatment is medical, and surgery reserved for those who failed medical therapy. Considerable progresses have been made in the surgical therapy of CD over the past two decades. Some surgical interventions such as those consisting in the resection of long segments or leading to a definitive stoma should be avoided and performed only in case of treatment failure. On the other side, well-indicated and minimal invasive surgery can be considered as an alternative to long-term medical therapy for certain indications. The decision of performing early surgery should take in account the strategy that will be applied post-operatively. Decision making in multidisciplinary teams is paramount.

Keywords: Crohn's disease; Medical treatment; Surgical treatment; Timing.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Crohn Disease / diagnosis
  • Crohn Disease / surgery*
  • Decision Making
  • Female
  • Humans
  • Ileal Diseases / surgery
  • Male
  • Rectal Diseases / surgery
  • Time Factors
  • Young Adult