Inflammatory Bowel Disease (cont.)
Francisco Talavera, PharmD, PhD
Surgical treatment in persons with inflammatory bowel disease varies, depending upon the disease. Ulcerative colitis is a surgically curable disease because the disease is limited to the colon. However, surgical resection is not
curative in persons with Crohn's disease. On the contrary, excessive surgical intervention in persons with Crohn's disease can lead to more problems. Situations arise in Crohn's disease in
which surgery without resection can be used. This is done to halt function of the colon in order possibly to allow for healing of the disease distal to the site where surgery is done.
- In about 25% of 30% of persons with ulcerative colitis, medical treatment is not completely successful. In such persons and in persons with dysplasia (changes in the cells that are considered a precursor to cancer), surgery may be
considered. Unlike Crohn's disease, which can recur after surgery, ulcerative colitis is cured after colectomy (surgical removal of the colon).
- The surgical options for persons with ulcerative colitis depend on a number of factors: the extent of the disease, the person's age, and his overall health. The first option involves the
removal of the entire colon and rectum (proctocolectomy) with the creation of an opening on the abdomen through which feces is emptied into a pouch (ileostomy). This pouch is attached to the skin with an adhesive.
- The other most commonly used option is a technically demanding surgery and is generally a multistage procedure. The surgeon removes the colon, creates an internal ileal pouch from the small intestine, attaches it to the anal sphincter muscle (ileoanal anastomosis), andcreates a temporary ileostomy. After the ileoanal anastomosis heals, the ileostomy is closed and the passage of the feces
through the anus is reestablished.
- Even though surgery is not curative in persons with Crohn's disease, approximately 75% of persons will require surgery at some point of time (especially for complications). The most simple
surgery for Crohn's disease is the segmental resection, in which a segment of intestine with active disease or a stricture (narrowing) is removed
and the remaining bowel is reanastomosed (two ends of healthy bowel are joined together).
- In persons with a very short stricture, instead of removal of that part of the intestine, a bowel-sparing stricturoplasty (repair) can be performed.
- Ileorectal or ileocolonic anastomosis is an option is some persons who have lower small intestine or upper colon disease.
- In persons with severe perianal fistulae, diverting ileostomy/colostomy is a surgical option. In this procedure, the function is halted for the distal colon and a temporary ileostomy or colostomy is created. The rectum, for which function is halted, is allowed to heal, and the ileostomy/colostomy is then reversed.
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