[Operative therapy of chronic inflammatory bowel diseases. Indications and importance]. / Operative Therapie chronisch-entzündlicher Darmerkrankungen. Indikationen und Stellenwert.

ABSTRACT

BACKGROUND: The impact of surgery in the treatment of inflammatory bowel disease (IBD) is considered as secondary whereas conservative treatment remains the first choice. Surgery is designated for a complicated or refractory disease course. Furthermore, there seems to be prophylactic aspects as well, such as ileocecal resection in Crohn's disease and prophylactic restorative coloproctectomy for intraepithelial neoplasia associated with ulcerative colitis. AIM: This review evaluates the impact of surgery in the treatment of Crohn's disease and ulcerative colitis in view of existing data in the literature. MATERIAL AND METHODS: The results in the literature are reviewed and retrospective data from this institution are presented. RESULTS: The manifestation of Crohn's disease is mainly ileocecal, colorectal, enteric and anorectal. The role of surgery is discussed according to the localization, extent of the disease and the clinical course. The emphasis is on longstanding Crohn's proctitis with fistulas and stenosis which are still challenging. The results indicate that intersphincteric rectal resection with pull through of the rectum and hand-sewn anastomosis represents a good option in up to 67 % of cases to avoid permanent stoma in highly selected patients. In addition, this procedure provides high rates of fistula healing as well as low recurrence rate of the anorectal stenosis. Pouch surgery in ulcerative colitis can be offered in high volume centers with low morbidity and functional results remain stable over time. Postoperative quality of life seems to be good with regard to general and disease-related quality of life. DISCUSSION: Interdisciplinary approaches should increasingly focus on prophylactic aspects of surgical options while conservative treatment will be enhanced by new therapeutic agents.