Surgery may be considered for those with inadequate response to, nonadherence with medical therapy
THURSDAY, Aug. 6, 2020 (HealthDay News) — In clinical practice guidelines from the American Society of Colon and Rectal Surgeons, published in the August issue of Diseases of the Colon & Rectum, recommendations are presented for indications and considerations before, during, and after surgery for Crohn disease (CD).
Amy L. Lightner, M.D., from the Cleveland Clinic, and colleagues conducted a systematic literature review of 312 articles to develop recommendations focusing on surgical management of patients with CD.
The researchers note that surgery should typically be considered for patients who demonstrate an inadequate response to, develop complications from, or are nonadherent with medical therapy. Surgery should be performed in patients with severe acute colitis who do not adequately respond to medical therapy or who have signs or symptoms of impending or actual perforation. For those with symptomatic small-bowel or anastomotic strictures that are not amenable to medical therapy and/or endoscopic dilation, surgery is indicated. Patients should be weaned from glucocorticoids before surgical intervention due to an increased risk for postoperative infectious complications. For patients with CD, smoking cessation may reduce postoperative morbidity. A minimally invasive approach should be considered for CD surgery. Patients should be considered for medical therapy to treat residual disease or to maintain disease remission after surgery for CD.
“We hope these guidelines will offer guidance in navigating the increasingly complex and multidisciplinary management of Crohn disease,” Lightner said in a statement.
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