Expert review of gastroenterology & hepatology · 2020
Perioperative management of ileocecal Crohn's disease in the current era.
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Yamamoto Takayuki, Lightner Amy Lee, Spinelli Antonino, Kotze Paulo Gustavo
Аннотация
INTRODUCTION: The ileocecal region is most commonly involved in patients with Crohn's disease (CD).
AREAS COVERED: In the management of ileocecal CD, this review discusses the underlying clinical issues with perioperative management and surgical intervention.
EXPERT OPINION: Despite advances in medical treatments, surgery is required in a proportion of patients. Preoperative optimization including weaning of corticosteroids, initiation of enteral feeds, venous thromboembolism prophylaxis and smoking cessation may lead to improved postoperative outcomes. Several surgical approaches regarding anastomotic technique and range of mesentery division are now attempted to reduce the incidence of postoperative recurrence. Disease recurrence is common after surgery for CD. Early endoscopic assessment and subsequent treatment adjustment are optimal strategies for the prevention of recurrence after ileocolonic resection.
AREAS COVERED: In the management of ileocecal CD, this review discusses the underlying clinical issues with perioperative management and surgical intervention.
EXPERT OPINION: Despite advances in medical treatments, surgery is required in a proportion of patients. Preoperative optimization including weaning of corticosteroids, initiation of enteral feeds, venous thromboembolism prophylaxis and smoking cessation may lead to improved postoperative outcomes. Several surgical approaches regarding anastomotic technique and range of mesentery division are now attempted to reduce the incidence of postoperative recurrence. Disease recurrence is common after surgery for CD. Early endoscopic assessment and subsequent treatment adjustment are optimal strategies for the prevention of recurrence after ileocolonic resection.