Operative and perioperative treatment of patients with inflammatory bowel disease

Abstract

The ileal–anal pouch continues to be the most significant advance in the operative treatment of patients with ulcerative colitis during the past decade. Reports no longer question the efficacy of this innovative operation and now focus on improvements in operative technique and postoperative management. The goal of operative management of patients with Crohn's disease continues to be a conservative one. Recent evidence demonstrates that histologic recurrence of disease at the anastomosis occurs very soon after resection. Transplantation of the small intestine is an operative treatment on the horizon for patients with short-bowel syndrome due to conditions such as Crohn's disease. Advances continue in perioperative nutritional-metabolic management of patients with inflammatory bowel disease. Use of perioperative total parenteral nutrition is becoming more restrictive in patients with ulcerative colitis. Because of its significant enterotrophic effect, reduced cost, and comparable outcome benefit when compared with total parenteral nutrition, perioperative enteral nutrition is being prescribed more frequently. Observations in experimental models of enterocolitis have demonstrated enhancement of gut growth and function due to the provision of intestinal nutrients such as glutamine for the small intestine and short-chain fatty acids for the colon.