What are the ASCRS guidelines for surgical procedures for Crohn disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

Approximately 85-90% of patients develop disease recurrence within the first postoperative year. Therefore, every attempt at conserving the small bowel should be made in the surgical approach to Crohn disease. However, repeated intestinal resection for Crohn disease is a major cause of short bowel syndrome. Several agents have been shown to decrease the likelihood of disease recurrence in individuals who have had ileocolic resections, including antibiotics, azathioprine/6-MP, and biologic agents. [126, 127, 128, 129, 130]

The ASCRS has identified recommended surgical procedures for site-specific Crohn disease (see Table 3, below). [7]

Table 3. ASCRS Recommendations for Site-Specific Operative Management of Crohn Disease (Open Table in a new window)

Site

Surgical Intervention

Terminal ileum, ileocolon, upper GI tract

  • Resection of the affected bowel for jejunal, proximal ileal, terminal ileal, or ileocolic disease in the absence of existing or impending short bowel syndrome

  • Ileocolostomy or proximal loop ileostomy in cases where there is concern about damage to nondiseased bowel, superior mesenteric vessels, retroperitoneal structures

  • Drainage of any septic foci with later definitive resection (after several months’ delay)

  • Strictureplasty for nonphlegmonous jejunal, ileal, or ileocolic strictures in the absence of existing or impending short bowel syndrome

  • Strictureplasty when multiple jejunal or proximal/terminal ileum strictures are present

  • Bypass or strictureplasty for symptomatic gastric or duodenal disease

  • Endoscopic dilatation of symptomatic, accessible strictures of the intestinal tract

Note: Surgical services should be available in case of perforation

Colon

  • Subtotal or total colectomy with end ileostomy for colonic disease requiring emergency or urgent surgery (via laparoscopic or open approach)

  • Segmental or total colectomy with or without primary anastomosis for colonic disease requiring elective surgery

  • Total proctocolectomy or proctectomy with stoma creation for rectal disease requiring surgery

ASCRS = American Society of Colon and Rectal Surgeons; GI = gastrointestinal.

Source:  Strong SA, Koltun WA, Hyman NH, Buie WD, for the Standards Practice Task Force of The American Society of Colon and Rectal Surgeons. Practice parameters for the surgical management of Crohn’s disease. Dis Colon Rectum. 2007;50(11):1735-46. [7]


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