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  • Review Article
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Patient optimization for surgery relating to Crohn's disease

Nature Reviews Gastroenterology & Hepatology volume 13, pages 707–719 (2016)Cite this article

Subjects

Key Points

  • Patient optimization of modifiable risk factors before abdominal surgery for Crohn's disease reduces perioperative complications including postoperative intra-abdominal septic complications

  • Cross-sectional imaging is required to define extent, severity and complications arising from penetrating Crohn's disease

  • Optimizing nutritional status before surgery reduces postoperative intra-abdominal septic complications and the need for a temporary diverting stoma

  • Preoperative treatment of abdominal abscesses or phlegmons substantially reduces all postoperative complications, the need for a temporary diverting stoma and increases the likelihood of a laparoscopic approach

  • Correction of preoperative anaemia reduces postoperative complications including intra-abdominal abscess, anastomosis leak and postoperative perforation

Abstract

The majority of patients with Crohn's disease require abdominal surgery during their lifetime, some of whom will require multiple operations. Postoperative complications are seen more frequently in patients requiring abdominal surgery for Crohn's disease than in patients requiring abdominal surgery for other conditions. In this article, we review the evidence supporting preoperative optimization, discussing strategies that potentially improve surgical outcomes and reduce perioperative morbidity and mortality. We discuss the roles of adequate cross-sectional imaging, nutritional optimization, appropriate adjustments of medical therapy, management of preoperative abscesses and phlegmons, smoking cessation and thromboembolic prophylaxis. We also review operation-related factors, and discuss their potential implications with respect to postoperative complications. Overall, the literature suggests that preoperative management has a major effect on postoperative outcomes.

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Figure 1: An example of phlegmonous Crohn's disease requiring 6 weeks treatment with broad-spectrum antibiotics.
Figure 2: An example of stricturing Crohn's disease with associated prestenotic dilatation.
Figure 3: MRI demonstrating fistulizing Crohn's disease.
Figure 4: A treatment approach to a patient requiring surgery for Crohn's disease.

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Authors and Affiliations

  1. Department of Gastroenterology, IBD Centre, First Floor College House, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    Kamal V. Patel, Jeremy D. Sanderson & Peter M. Irving

  2. Department of Colorectal and General Surgery, First Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    Amir A. Darakhshan & Andrew B. Williams

  3. Department of Radiology, First Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    Nyree Griffin

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  1. Kamal V. Patel
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  2. Amir A. Darakhshan
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  3. Nyree Griffin
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  4. Andrew B. Williams
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  5. Jeremy D. Sanderson
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  6. Peter M. Irving
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Contributions

P.M.I. researched data for the article, contributed to discussion of content and reviewed/edited the manuscript before submission. K.V.P. researched data for the article, contributed to discussion of content and wrote the article. A.A.D. contributed to discussion of content and reviewed/edited the manuscript before submission. N.G. wrote the article. A.B.W and J.D.S. reviewed/edited the manuscript before submission.

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Correspondence to Peter M. Irving.

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Patel, K., Darakhshan, A., Griffin, N. et al. Patient optimization for surgery relating to Crohn's disease. Nat Rev Gastroenterol Hepatol 13, 707–719 (2016). https://doi.org/10.1038/nrgastro.2016.158

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