Peter Kienle1. 1. Department of Surgery, Theresienkrankenhaus und St. Hedwig-Klinik GmbH, Mannheim, Germany.
Abstract
BACKGROUND: A significant number of patients with Crohn's disease needs to undergo surgery, and many of these patients are under modern drug treatment. These drugs may influence the rate of perioperative complications. This may have an impact on the chosen surgical strategy. METHODS: This review considers clinical studies and guidelines on the effect of modern drug treatment on surgical complication rates and surgical strategy in patients with Crohn's disease. RESULTS: Steroids above a certain dose significantly influence perioperative complications and should therefore be tapered down before performing elective surgery. Anti-TNF-alpha drugs are associated with perioperative complications, and therefore a safe interval between drug intake and surgery should be adhered to. The data on newer biologicals is scarce and conflicting; thus, it seems prudent to wait at least for one dosing interval before operating. In the emergency setting, patients undergoing bowel resection while on the above medications without an adequate interval to the last medication dose should generally get a resectional or diverting stoma. CONCLUSION: Modern drug treatment influences the surgical strategy in patients with Crohn's disease.
BACKGROUND: A significant number of patients with Crohn's disease needs to undergo surgery, and many of these patients are under modern drug treatment. These drugs may influence the rate of perioperative complications. This may have an impact on the chosen surgical strategy. METHODS: This review considers clinical studies and guidelines on the effect of modern drug treatment on surgical complication rates and surgical strategy in patients with Crohn's disease. RESULTS: Steroids above a certain dose significantly influence perioperative complications and should therefore be tapered down before performing elective surgery. Anti-TNF-alpha drugs are associated with perioperative complications, and therefore a safe interval between drug intake and surgery should be adhered to. The data on newer biologicals is scarce and conflicting; thus, it seems prudent to wait at least for one dosing interval before operating. In the emergency setting, patients undergoing bowel resection while on the above medications without an adequate interval to the last medication dose should generally get a resectional or diverting stoma. CONCLUSION: Modern drug treatment influences the surgical strategy in patients with Crohn's disease.
Entities:
Keywords:
Biologicals; Crohn's disease; Immunosuppressive treatment; Surgery
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