TY - CHAP M1 - Book, Section TI - Inflammatory Bowel Disease: Surgical Considerations A1 - Irani, Jennifer L. A1 - Bleday, Ronald A2 - Greenberger, Norton J. A2 - Blumberg, Richard S. A2 - Burakoff, Robert Y1 - 2016 N1 - T2 - CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e AB - ESSENTIAL CONCEPTSUlcerative ColitisSurgery is indicated when (1) chronic intractable disease is not controlled with medication, or drug side effects are too severe; (2) patients with severe colitis require an urgent procedure; or (3) dysplasia or cancer is present.Most patients needing surgery are candidates for an ileoanal pouch anastomosis (IPAA); the main considerations are age, gender, type of job, and lifestyle.In most patients undergoing IPAA, a temporary diverting loop ileostomy is constructed to decrease the likelihood of pelvic sepsis.Laparoscopic-assisted and open IPAA give equivalent results.Crohn DiseaseIn general, surgery is indicated for complications (ie, abscess, fistula, perforation, obstruction); considerations include symptom severity, medical treatment failure or side effects, and operative risk.Most patients found to have Crohn disease at laparotomy for suspected appendicitis require early ileocolic resection.Perianal Crohn disease activity can be assessed using the Perianal Crohn Disease Activity Index.Surgical procedures for treatment of fistula-in-ano include fistulotomy, long-term draining setons, endoanal flap closure, and ligation of intersphincteric fistula tract, if the rectal mucosa is normal.Recent innovative therapy for anal fistula involves adhesive products, fibrin glue, and bioprosthetic plugs of porcine collagen. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=1119985307 ER -