J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text HTML] [Full Text PDF] （in Japanese / 306KB） [Members Only]

J.Jpn. Surg. Soc.. 116(2): 94-98, 2015

Feature topic

SURGICAL MANAGEMENT OF INTESTINAL CROHN'S DISEASE

1) Department of Surgery, Sendai Red Cross Hospital, Sendai, Japan
2) Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan
3) Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

Yuji Funayama1), Hideyuki Suzuki1), Ken-ichi Takahashi2), Sho Haneda2), Kazuhiro Watanabe3), Fumie Ikezawa3), Michiaki Unno3)

Various intestinal conditions such as stricture, fistula, abscess, perforation, and hemorrhage are complications of Crohn's disease. Surgical intervention remains important, even in the era of biologic therapy. Limited surgical resection is essential to avoid short bowel syndrome after massive resection or multiple operations. Strictureplasty is effective for short, isolated stricture of the small intestine and provides good results equivalent to those of intestinal resection. Fecal diversion in the case of very complicated lesions not suitable for immediate resection can offer patients general and local improvement. Although bypass surgery is currently not performed because of the possibility of deterioration or carcinogenesis of the bypassed segment, bypass surgery is useful for avoiding stoma. Laparoscopic surgery is indicated for patients with nonperforating, localized ileocecal lesions, and for those presenting initially. The cumulative postoperative reoperation rate is about 50% to 60% at 10 years. The risk factors for early recurrence are smoking, perforating type, previous reoperation, and small intestinal disease. During postoperative follow-up and maintenance treatment, the importance of an algorithm comprising regular check-ups with ileocolonoscopy and the use of thioprines and biologics has been proposed.

<< To previous pageTo next page >>

To read the PDF file you will need Adobe Reader installed on your computer.