Surgery for Inflammatory Bowel Disease in the Era of Biologics

Abstract

IntroductionThe advent of monoclonal antibody therapy for the treatment of inflammatory bowel disease has greatly changed the multidisciplinary management of these patients, including surgical approaches. As an increasing number of inflammatory bowel disease patients are being medically managed with monoclonal antibody therapy or combination therapy with immunomodulators, more patients are coming to the operating room having been exposed to these medical therapies. MethodsA search of the relevant literature regarding monoclonal antibody therapy and postoperative outcomes was performed. ResultsSignificant controversy remains regarding the association between monoclonal antibodies and postoperative outcomes. Different classes of monoclonal antibodies may have different impacts on infectious complications. Operations for Crohn’s disease and ulcerative colitis alter how we think about a change in care in the era of monoclonal antibodies. ConclusionIn Crohn's disease, intestinal diversion may be considered in patient and disease specific scenarios and in ulcerative colitis, the use of a 3-stage approach to an ileal pouch is now more often used.