Inflammatory bowel disease surgery in the biologic therapy era

Abstract

The relationship between surgery and biologic agents in the management of patients with inflammatory bowel disease continues to be a source of interest for both surgeons and clinicians. The role of biologic agents in patients with varying presentations of Crohn's disease or ulcerative colitis continues to evolve. However, the currently available biologic therapies are clearly not the panacea we have desired because they have only marginally decreased the frequency with which operative intervention is required and may have increased the risk for infectious postoperative complications in the nonelective setting. Compared to surgery, biologic agents are also significantly more costly and may not provide any greater gain in quality of life. Future studies must focus on the use of surgery and emerging biologic agents as complementary therapies designed to safely control inflammatory disease while providing objective value.