Surgery for CD is not curative thus patients will continue to require follow-up for disease recurrence and prophylactic treatment. Risk factors for post-surgical recurrence include:
Prior intestinal surgeries
Penetrating disease behaviour
Extensive small bowel resection
Post–operatively, all IBD patients, regardless of their risk for recurrence, are advised to undergo a colonoscopy at 6 to 12 months after surgical intervention to evaluate for endoscopic evidence of Crohn’s disease. Post-surgical patient in whom disease recurrence is suspected, should be immediately referred to a specialist to setup a long–term maintenance therapy and surveillance.
Pouchitis is the most common complication in UC patients who have undergone the total colectomy with subsequent construction of an ileal pouch anal-anastomosis (IPAA). It is an active inflammation of the mucosa in the ileal reservoir (pouch). Up to 50% of UC patients who underwent IPAA surgery develop at least one episode of pouchitis during their lifetime.
Symptoms of pouchitis are non-specific and can be confused with disease relapse. This includes increased stool frequency and liquidity, abdominal cramping, urgency, tenesmus, and pelvic discomfort. Patients who experience these symptoms should be referred to specialists for an endoscopy and biopsy to confirm the diagnosis.
Treatment of pouchitis is based on whether this complication is acute or chronic:
- Metronidazole or ciprofloxacin
- Anti-diarrheal drugs can be used for symptomatic relief
Chronic pouchitis (>4 weeks duration):
- Empiric combined antibiotic treatment, such as imidazole antibiotic, and rifaximin
- VSL#3 has been successfully used in this situation
To learn more about various aspects of surgery in IBD, please, go back to the IBD Surgery page
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