Many patients with
Crohn's disease (CD) require surgery. Indications for surgery include failure of medical treatment, bowel obstruction,
fistula or
abscess formation. The most common
surgical procedure is resection. In jejunoileal CD, strictureplasty is an accepted surgical technique that relieves the obstructive symptoms, while preserving intestinal length and avoiding the development of
short bowel syndrome. However, the role of strictureplasty in duodenal and
colonic diseases remains controversial. In extensive
colitis, after total
colectomy with ileorectal anastomosis (IRA), the recurrence rates and functional outcomes are reasonable. For patients with extensive
colitis and rectal involvement, total
colectomy and end-
ileostomy is safe and effective; however, a few patients can have subsequent IRA, and half of the patients will require
proctectomy later.
Proctocolectomy is associated with a high incidence of delayed perineal wound healing, but it carries a low recurrence rate. Patients undergoing
proctocolectomy with
ileal pouch-anal anastomosis had poor functional outcomes and high failure rates. Laparoscopic surgery has been introduced as a minimal invasive procedure. Patients who undergo laparoscopic surgery have a more rapid recovery of bowel function and a shorter
hospital stay. The morbidity also is lower, and the rate of disease recurrence is similar compared with open procedures.