RT Book, Section
A1 Irani, Jennifer L.
A1 Bleday, Ronald
A2 Greenberger, Norton J.
A2 Blumberg, Richard S.
A2 Burakoff, Robert
SR Print(0)
ID 1119985307
T1 Inflammatory Bowel Disease: Surgical Considerations
T2 CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071837729
LK accessmedicine.mhmedical.com/content.aspx?aid=1119985307
RD 2024/04/20
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.