Crohn's Disease and Ulcerative Colitis Surgical Management

Abstract

In the surgical management of Crohn's disease and ulcerative colitis, two methodical changes have evolved to the otherwise constant concept. In the case of Crohn's disease, surgery should not be delayed until complications arise, but an early operation is justified in the case of segmental affection. The indication of surgery in the case of ulcerative colitis has taken on a new aspect with regard to carcinoma prophylaxis due to the histological discovery of precancerous lesions of the intestinal mucous membrane. If this histological differentiation is possible and a followup examination can be arranged with the patient, a more flexible approach with regard to carcinoma prophylaxis is justified, even if the duration of the disease reaches ten years. This is especially true in cases where colon and rectum are not completely affected. Continent ileostomy according to Kock still requires a great deal of experience, whereas ileorectal anastomosis, especially in the treatment of Crohn's disease and in some appropriate cases of ulcerative colitis, can be an alternative, albeit temporary, to proctocolectomy. For a successful therapy of chronic-inflammatory diseases of the intestine, a great deal of experience resulting from treatment of a large number of patients is necessary, as well as the possibility of interdisciplinary treatment using all diagnostic and therapeutic methods available. Apart from the surgical techniques used, the individual course of the disease is a decisive factor determining prognosis. Although the surgeon, through the operation, is therapeutically responsible for only one stage of the disease, he should observe the course of the disease together with a cooperating internist throughout the treatment in order to indicate an operation in time.