Surgery for luminal Crohn’s disease

Table 1 Five "Golden Rules" of surgical management of Crohn’s disease[4]

Crohn’s disease is a panintestinal disease, with intermittent activity and the potential of focal exacerbations throughout the patient’s life

It is impossible to cure Crohn’s disease by excision. The surgeon is required only to treat the complications

The essence of surgical treatment is to make the operation as safe as possible. If the operation becomes safe and patients survive, they will inevitably have recurrences and so repeated operations may be required. Therefore, it is important to conserve as much gut as possible

All diseased bowels need not be excised, only that part with complications

If only stenotic complications are being treated, perhaps the stenosis can be simply widened by strictureplasty or dilatation

Table 2 Contraindications to strictureplasty

Excessive tension due to rigid and thickened bowel segments

Perforation of the intestine

Fistula or abscess formation at the intended strictureplasty site

Hemorrhagic strictures

Multiple strictures within a short segment

Malnutrition or hypoalbuminemia (< 2.0 g/dL)

Suspicion of cancer at the intended strictureplasty site

Table 3 Rate of functional ileorectal anastomosis after a total colectomy for extensive Crohn’s colitis at 10 years

Ref.	n	Functioning ileorectal anastomosis
Buchmann et al[40]	105	70%
Ambrose et al[41]	63	71%
Longo et al[42]	118	48%
Chevallier et al[43]	83	63%
Pastore et al[44]	42	65%
Yamamoto et al[45]	65	78%
Bernell et al[46]	106	76%
Cattan et al[47]	118	86%

Table 4 Rate of secondary proctectomy for defunctioned rectum after a total colectomy with end-ileostomy for extensive Crohn’s colitis

Ref.	n	Follow-up (yr)	Secondary proctectomy
Harling et al[48]	59	7.7	50%
Guillem et al[49]	47	6	51%
Sher et al[50]	25	6	40%
Yamamoto et al[51]	65	10	54%