Perioperative management of ileocecal Crohn’s disease in the current era

ABSTRACT

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.

KEYWORDS:

• Crohn’s disease
• ileocecal region
• biologic therapy
• anti-TNF agents
• preoperative optimization
• surgery
• ileocecal resection
• ileocolonic resection
• recurrence

Declaration of interest

A Lightner has received consultancy honoraria from Takeda. A Spinelli has received consultant honoraria from Takeda, Tigenix and Ethicon. P Kotza has received speaking and consultancy honoraria from AbbVie, Janssen, Pfizer, Takeda and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.