Crohn's disease

While considering surgical options for CD, the following realistic expectations should be taken into account:

  • Surgery for CD is not curative
  • Long–term maintenance therapy will still be required post-surgery on long–term basis after surgery to prevent postoperative recurrence and further complications
  • Inflammatory changes and architectural abnormalities in CD often have focal or patchy character. As a result, surgical resection of areas affected by CD is difficult
  • The chance of post-operative recurrence within a 10-year period is approximately 50%. About 20% of patients show a recurrence after two years, 30% – after three years, and up to 80% – by 20 years. Not all recurrences require re-operation
  • Postoperative disease recurrence is almost always located at or in front of the site of anastomosis
  • Recurrence rates seem to be lower when the initial operation is to relieve a blockage. In contrast, recurrence rates seem to be higher in more "aggressive" disease, e.g., illness that involves ulcerations, abscesses, or fistulas (an abnormal channel that forms between two loops of intestine, or runs from the intestine to another organ)
  • A few options are available in the surgical management of CD and some of those may require more than one surgical procedure
  • Patients with CD may require several operations throughout their lifetime, and an estimated 65% to 75% of persons with Crohn's disease will have one or more operations in the course of their lifetimes. Therefore, surgical resections are often conservative

 

Ulcerative colitis

In consideration of surgery in UC, the following should be beared in mind:

  • Approximately 15%-45% of UC patients will require surgery in their lifetime
  • Removal of the colon and rectum (proctocolectomy) in UC is curative. Eventually, it eliminates the possibility of malignancy (most important risk factors for ulcerative colitis-associated colorectal cancer are the longer duration, extent of disease, dysplasia, and presence of primary sclerosing cholangitis) and provides relief from symptoms
  • In UC, the abnormalities in the large intestine are indeed much more widespread than in CD. UC affects the colon and rectum in a continuous manner which makes resection easier than in CD
  • Several options are available in the surgical management of UC and some of those may require more than one surgical procedure
 
To learn more about various aspects of surgery in IBD, please, go back to the IBD Surgery page
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References and Acknowledgments