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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 28, 2008; 14(36): 5532-5539
Published online Sep 28, 2008. doi: 10.3748/wjg.14.5532
Timing of surgery in Crohn’s disease: A key issue in the management
Rafael Alós, Joaquín Hinojosa
Rafael Alós, Servicio de Cirugía General, Unidad de Colopro-ctología, Hospital de Sagunto, Valencia, Spain
Joaquín Hinojosa, Unidad de Digestivo, Servicio de Medicina Interna, Hospital de Sagunto, Valencia, Spain
Author contributions: Alós R and Hinojosa J contributed equally to this work.
Correspondence to: Rafael Alós, Servicio de Cirugía General, Unidad de Coloproctología, Hospital de Sagunto, Valencia, Spain. alos_raf@gva.es
Telephone: +34-96-2659414 Fax: +34-96-2659420
Received: August 18, 2008
Revised: August 26, 2008
Accepted: September 3, 2008
Published online: September 28, 2008
Abstract

The timing of the decision for operation in Crohn’s disease is based on an evaluation of the several factors such as the failure of medical treatment, complications due to the Crohn’s disease or to the farmacological therapy, development of dysplasia or cancer and growth retardation. A complete evaluation of these factors should result in operation timed to the patient’s best advantage, achieving maximal relief of symptoms with improvement of quality of life. Given the complexity and heterogeneity of the disease and the different options for treatment, is difficult to systematize when the optimal moment for the surgery is arrived. A very important factor in the management of Crohn’s disease is the multidisciplinary approach and the patient preference should be a significant factor in determining the choice of therapy. The surgery should be considered such another option in the sequential treatment of Crohn’s disease. We have analyzed the factors that are involved in the decision taking of the surgical treatment regarding to the experience and the published literature. When did the medical therapy fail? when is the appropriate moment to operate on the patient? Or which complications of Crohn’s disease need a surgery? These are some of the questions we will try to answer.

Keywords: Crohn’s disease, Surgical treatment, Medical therapy