Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Table 1 Main indications for surgery in patients with Crohn’s disease

Indications	Treatment
Bowel obstruction	Conservative: Elimination of inflammation. On failure: Surgical resection of narrowed segment or endoscopic balloon dilatation
Intraabdominal abscess	Percutaneous drainage - administration of antibiotics. Surgery: Failure to improve septic symptoms, abscess rupture, multiple abscesses, enterectomy
Presence of fistulae	Simple fistulae: Pharmaceutical agents, enteral nutrition, biologic agents. Complex enteric fistulae: Surgery, treatment of sepsis, nutritional support
Perianal disease	Fistulae: Multidisciplinary approach, antibiotics, biological agents, surgery, stems cells. Abscess: Surgical drainage, antibiotics
Perforation	Emergency surgery
Massive bleeding	Conservative, endoscopic, invasive hemostasis. On failure: Emergency surgery
Malignancy	Absolute indication for surgery
Failure of conservative treatment	Drug intolerance, failure of biological agents, antibiotics, enteral nutrition, and total parenteral nutrition

Table 2 Main indications for surgery in ulcerative colitis

Indications	Treatment
Emergency situations
Acute severe UC refractory to medical treatment	70% of patients will eventually need surgery
Uncontrollable sepsis
Colonic perforation	Surgery – antibiotics
Toxic megacolon	Emergency operation
Severe bleeding	Emergency operation. Colectomy should not be delayed
Elective indications
Dysplasia	Endoscopic surveillance with targeted biopsies for early detection. In cases of dysplasia endoscopic resection and continued surveillance. Surgery for unresectable dysplasia, and multi-focal low-grade dysplasia
Cancer	Surgical treatment
Medically refractory disease	Surgical treatment (preferably IAPA)

UC: Ulcerative colitis; IAPA: Ileo-anal-pouch anastomosis.