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World J Gastrointest Surg. May 27, 2016; 8(5): 363-370
Published online May 27, 2016. doi: 10.4240/wjgs.v8.i5.363
Inflammatory bowel disease surgery in the biologic era
Linda Ferrari, Mukta K Krane, Alessandro Fichera
Linda Ferrari, Mukta K Krane, Alessandro Fichera, University of Washington Medical Center, Seattle, WA 98195-6410, United States
Author contributions: All the authors designed the study and wrote the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alessandro Fichera, MD, FACS, FASCRS, University of Washington Medical Center, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195-6410, United States. afichera@uw.edu
Telephone: +1-206-6165709
Received: September 29, 2015
Peer-review started: October 2, 2015
First decision: November 4, 2015
Revised: January 13, 2016
Accepted: March 9, 2016
Article in press: March 14, 2016
Published online: May 27, 2016
Processing time: 231 Days and 7.2 Hours
Abstract

Anti-tumour necrosis factor (TNF)-α therapy has revolutionized inflammatory bowel disease (IBD) treatment. Infliximab and adalimumab either as monotherapy or in combination with an immunomodulator are able to induce clinical and biological remission in patients with moderate and severe Crohn’s disease (CD) and ulcerative colitis (UC). These new therapies have led to a shift in the goals of IBD management from just controlling clinical symptoms to preventing disease progression. However, despite these advances in medical therapy, surgery is still required in 30%-40% of patients with CD and 20%-30% of patients with UC at some point during their lifetime. While biologics certainly play a major role in the medical treatment of IBD, there is concern about the effects of these anti-TNF-α agents on postoperative complications and morbidity. The purpose of this article is to review the role of surgery in the treatment of IBD in the age of biologics and the impact of these medications on per-operative outcomes. In this manuscript we review the relationship between biologic agents and surgery in the treatment of IBD. We also discuss in detail the periopetative risks and complications.

Keywords: Inflammatory bowel disease; Anti-tumour necrosis factor alpha agents; Ulcerative colitis; Crohn’s disease; Infliximab

Core tip: We review the relationship between biologic agents and surgery in the treatment of inflammatory bowel disease. We also discuss in detail perioperative risks and complications in this setting.