Surgery
Surgery is indicated for patients with persistent symptoms despite high-dose corticosteroids, treatment-related complications including intra-abdominal abscesses, medically intractable fistulae, fibrotic strictures with obstructive symptoms, toxic megacolon, haemorrhage, and cancer.
The primary goals of surgery are to alleviate complications, achieve the best possible quality of life, and conserve as much bowel as possible.
By the 20th year of onset of symptoms, approximately 75% of patients with Crohn disease will have had surgery. Unlike ulcerative colitis, Crohn's disease cannot be cured with surgery. Even if the diseased portion of the intestine is removed, the inflammation can reappear in a previously unaffected portion of the intestine.
The type of surgical procedure depends on the type of complication, the severity of the illness, or the location of the disease in the intestines. Some surgical techniques are: strictureplasty, resection of the intestine with subsequent anastomosis, colectomy, proctolectomy, drainage of an abcess.
The postoperative recurrence rate remains high despite medical management in the postoperative period (Kornbluth A, 1998)Kornbluth A, Sachar DB, Salomon P. Crohn's disease. In: Feldman M, Scharschmidt BF, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management. Vol 2. 6th ed. Philadelphia, Pa: WB Saunders Co; 1998:1708-34.