Crohn's disease: rehabilitation after resection.

In general, the patient receiving surgery for Crohn's disease (CD) makes an uncomplicated recovery with a speed consistent with the degree of surgical 'insult' - which in these days of laparoscopic approach and minimalist resection often means very rapidly indeed. However, in the patient who has had repeated surgery and in those where there was profound intra-abdominal sepsis this may not be the case. A prolonged period of ileus is to be expected and patients may well require parenteral nutrition to support them through this time. A curious and incompletely understood form of functional short-bowel syndrome is also seen in these and other patients after CD resection. Despite apparently limited resection and known adequate residual bowel length, with more than 1.5 m of healthy small intestine remaining in continuity, some patients develop a high-output state with many litres of diarrhoea or stomal effluent each day. Fortunately, in most cases this resolves spontaneously, but the process may take months: again these individuals may need parenteral nutrition support (including home parenteral nutrition in some). Nutritional support is needed in a broader range of postoperative patients, however, and it is increasingly recognised that simply providing supplements and encouraging eating will not be enough to restore lean body mass and function unless it is combined with an exercise programme. Analogy with sports training helps both physicians and patients understand this better. The patient who has undergone CD surgery has often been ill for some time beforehand, and the psychological aspects of chronic disease and the changes brought about by surgery - especially the creation of a stoma - may themselves become the most prominent features of the rehabilitative phase. A multidisciplinary approach is clearly justified and should be made available to all post-operative patients as needed.