Download PDF
Clin Colon Rectal Surg 2007; 20(4): 314-321
DOI: 10.1055/s-2007-991031
© Thieme Medical Publishers

Restorative Operations for Crohn's Disease

Benjamin Person1 , Marat Khaikin1
  • 1Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
Further Information

Publication History

Publication Date:
16 October 2007 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Restoration of the continuity of the intestinal tract is one of the key concepts for maintaining the quality of life in patients with Crohn's disease. Restorative procedures have an important role in the scope of operative modalities for these patients. The authors review operative options aimed at fulfilling these goals including restorative partial small bowel resection; segmental, subtotal, and total colectomies; and ileal pouch anal anastomosis in patients with Crohn's disease.

KEYWORDS

Crohn's disease - small bowel resection - segmental colectomy - ileal pouch anal anastomosis

REFERENCES

  • 1 Strong S A. Surgery for Crohn's disease. In: Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD The ASCRS Textbook of Colon and Rectal Surgery. New York, NY; Springer 2007: 584-600
    Google Scholar
  • 2 Mahadevan U, Young-Fadok T. Crohn's disease of the colon. In: Wexner SD, Stollman N Diseases of the Colon. New York, NY; Informa Healthcare Inc 2007: 625-646
    Google Scholar
  • 3 Mekhjian H S, Switz D M, Watts H D, Deren J J, Katon R M, Beman F M. National Cooperative Crohn's Disease Study: factors determining recurrence of Crohn's disease after surgery.  Gastroenterology. 1979;  77(4 Pt 2) 907-913
    CrossrefPubMedGoogle Scholar
  • 4 Froehlich F, Juillerat P, Felley C et al.. Treatment of postoperative Crohn's disease.  Digestion. 2005;  71 49-53
    CrossrefPubMedGoogle Scholar
  • 5 Gasche C, Scholmerich J, Brynskov J et al.. A simple classification of Crohn's disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998.  Inflamm Bowel Dis. 2000;  6 8-15
    CrossrefPubMedGoogle Scholar
  • 6 Pennington L, Hamilton S R, Bayless T M, Cameron J L. Surgical management of Crohn's disease. Influence of disease at margin of resection.  Ann Surg. 1980;  192 311-318
    PubMedGoogle Scholar
  • 7 Fazio V W, Marchetti F, Church M et al.. Effect of resection margins on the recurrence of Crohn's disease in the small bowel. A randomized controlled trial.  Ann Surg. 1996;  224 563-571
    CrossrefPubMedGoogle Scholar
  • 8 Adloff M, Arnaud J P, Ollier J C. Does the histologic appearance at the margin of resection affect the postoperative recurrence rate in Crohn's disease?.  Am Surg. 1987;  53 543-546
    PubMedGoogle Scholar
  • 9 Cooper J C, Williams N S. The influence of microscopic disease at the margin of resection on recurrence rates in Crohn's disease.  Ann R Coll Surg Engl. 1986;  68 23-26
    PubMedGoogle Scholar
  • 10 Ikeuchi H, Kusunoki M, Yamamura T. Long-term results of stapled and hand-sewn anastomoses in patients with Crohn's disease.  Dig Surg. 2000;  17 493-496
    CrossrefPubMedGoogle Scholar
  • 11 Munoz-Juarez M, Yamamoto T, Wolf B G, Keighley M R. Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn's disease.  Dis Colon Rectum. 2001;  44 20-25
    PubMedGoogle Scholar
  • 12 Resegotti A, Astegiano M, Farina E C et al.. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn's disease surgery.  Dis Colon Rectum. 2005;  48 464-468
    CrossrefPubMedGoogle Scholar
  • 13 Sanfey H, Bayless T M, Cameron J L. Crohn's disease of the colon. Is there a role for limited resection?.  Am J Surg. 1984;  147 38-42
    CrossrefPubMedGoogle Scholar
  • 14 Longo W E, Ballantyne G H, Cahow C E. Treatment of Crohn's colitis. Segmental or total colectomy?.  Arch Surg. 1988;  123 588-590
    CrossrefPubMedGoogle Scholar
  • 15 Prabhakar L P, Laramee C, Nelson H, Dozois R R. Avoiding a stoma: role for segmental or abdominal colectomy in Crohn's colitis.  Dis Colon Rectum. 1997;  40 71-78
    CrossrefPubMedGoogle Scholar
  • 16 Tekkis P P, Purkayastha S, Lanitis S et al.. A comparison of segmental vs subtotal/total colectomy for colonic Crohn's disease: a meta-analysis.  Colorectal Dis. 2006;  8 82-90
    CrossrefPubMedGoogle Scholar
  • 17 Panis Y, Poupard B, Nemeth J, Lavergne A, Hautefeuille P, Valleur P. Ileal pouch/anal anastomosis for Crohn's disease.  Lancet. 1996;  347 854-857
    CrossrefPubMedGoogle Scholar
  • 18 Regimbeau J M, Panis Y, Pocard M et al.. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease.  Dis Colon Rectum. 2001;  44 769-778
    CrossrefPubMedGoogle Scholar
  • 19 Brown C J, Maclean A R, Cohen Z, Macrae H M, O'Connor B I, McLeod R S. Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure.  Dis Colon Rectum. 2005;  48 1542-1549
    CrossrefPubMedGoogle Scholar
  • 20 Tekkis P P, Heriot A G, Smith O, Smith J J, Windsor A C, Nicholls R J. Long-term outcomes of restorative proctocolectomy for Crohn's disease and indeterminate colitis.  Colorectal Dis. 2005;  7 218-223
    CrossrefPubMedGoogle Scholar
  • 21 Hyman N H, Fazio V W, Tuckson W B, Lavery I C. Consequences of ileal pouch-anal anastomosis for Crohn's colitis.  Dis Colon Rectum. 1991;  34 653-657
    PubMedGoogle Scholar
  • 22 Deutsch A A, McLeod R S, Cullen J, Cohen Z. Results of the pelvic-pouch procedure in patients with Crohn's disease.  Dis Colon Rectum. 1991;  34 475-477
    CrossrefPubMedGoogle Scholar
  • 23 Grobler S P, Hosie K B, Affie E, Thompson H, Keighley M R. Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn's disease.  Gut. 1993;  34 1384-1388
    CrossrefPubMedGoogle Scholar
  • 24 Fazio V W, Ziv Y, Church J M et al.. Ileal pouch-anal anastomoses complications and function in 1005 patients.  Ann Surg. 1995;  222 120-127
    CrossrefPubMedGoogle Scholar
  • 25 Sagar P M, Dozois R R, Wolff B G. Long-term results of ileal pouch-anal anastomosis in patients with Crohn's disease.  Dis Colon Rectum. 1996;  39 893-898
    CrossrefPubMedGoogle Scholar
  • 26 Peyregne V, Fransois Y, Gilly F N, Descos J L, Flourie B, Vignal J. Outcome of ileal pouch after secondary diagnosis of Crohn's disease.  Int J Colorectal Dis. 2000;  15 49-53
    CrossrefPubMedGoogle Scholar
  • 27 Mylonakis E, Allan R N, Keighley M R. How does pouch construction for a final diagnosis of Crohn's disease compare with ileoproctostomy for established Crohn's proctocolitis?.  Dis Colon Rectum. 2001;  44 1137-1142
    CrossrefPubMedGoogle Scholar
  • 28 de Oca J, Sanchez-Santos R, Rague J M et al.. Long-term results of ileal pouch-anal anastomosis in Crohn's disease.  Inflamm Bowel Dis. 2003;  9 171-175
    PubMedGoogle Scholar
  • 29 Braveman J M, Schoetz Jr D J, Marcello P W et al.. The fate of the ileal pouch in patients developing Crohn's disease.  Dis Colon Rectum. 2004;  47 1613-1619
    CrossrefPubMedGoogle Scholar
  • 30 Hartley J E, Fazio V W, Remzi F H et al.. Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn's disease.  Dis Colon Rectum. 2004;  47 1808-1815
    CrossrefPubMedGoogle Scholar
  • 31 Reese G E, Lovegrove R E, Tilney H S et al.. The effect of Crohn's disease on outcomes after restorative proctocolectomy.  Dis Colon Rectum. 2007;  50 239-250
    CrossrefPubMedGoogle Scholar
  • 32 Young-Fadok T M, Hall Long K, McConnell E J, Gomez Rey G, Cabanela R L. Advantages of laparoscopic resection for ileocolic Crohn's disease. Improved outcomes and reduced costs.  Surg Endosc. 2001;  15 450-454
    CrossrefPubMedGoogle Scholar
  • 33 Duepree H J, Senagore A J, Delaney C P, Brady K M, Fazio V W. Advantages of laparoscopic resection for ileocecal Crohn's disease.  Dis Colon Rectum. 2002;  45 605-610
    CrossrefPubMedGoogle Scholar
  • 34 Chen H H, Wexner S D, Weiss E G et al.. Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy.  Surg Endosc. 1998;  12 1397-1400
    CrossrefPubMedGoogle Scholar
  • 35 Ludwig K A, Milsom J W, Garcia-Ruiz A, Fazio V W. Laparoscopic techniques for fecal diversion.  Dis Colon Rectum. 1996;  39 285-288
    PubMedGoogle Scholar
  • 36 Milsom J W, Lavery I C, Bohm B, Fazio V W. Laparoscopically assisted ileocolectomy in Crohn's disease.  Surg Laparosc Endosc. 1993;  3 77-80
    PubMedGoogle Scholar
  • 37 Milsom J W, Hammerhofer K A, Bohm B, Marcello P, Elson P, Fazio V W. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn's disease.  Dis Colon Rectum. 2001;  44 1-8
    CrossrefPubMedGoogle Scholar
  • 38 Maartense S, Dunker M S, Slors J F et al.. Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial.  Ann Surg. 2006;  243 143-149
    CrossrefPubMedGoogle Scholar
  • 39 Thaler K, Dinnewitzer A, Oberwalder M, Weiss E G, Nogueras J J, Wexner S D. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn's disease.  Colorectal Dis. 2005;  7 375-381
    CrossrefPubMedGoogle Scholar
  • 40 Tilney H S, Constantinides V A, Heriot A G et al.. Comparison of laparoscopic and open ileocecal resection for Crohn's disease: a meta-analysis.  Surg Endosc. 2006;  20 1036-1044
    CrossrefPubMedGoogle Scholar
  • 41 Bauer J J, Harris M T, Grumbach N M, Gorfine S R. Laparoscopic-assisted intestinal resection for Crohn's disease.  Dis Colon Rectum. 1995;  38(7) 712-715
    CrossrefPubMedGoogle Scholar
  • 42 Wu J S, Birnbaum E H, Kodner I J, Fry R D, Read T E, Fleshman J W. Laparoscopic-assisted ileocolic resections in patients with Crohn's disease: are abscesses, phlegmons, or recurrent disease contraindications?.  Surgery. 1997;  122(4) 682-688
    CrossrefPubMedGoogle Scholar
  • 43 Dunker M S, Stiggelbout A M, van Hogezand R A, Ringers J, Griffioen G, Bemelman W A. Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn's disease.  Surg Endosc. 1998;  12(11) 1334-1340
    CrossrefPubMedGoogle Scholar
  • 44 Alabaz O, Iroatulam A J, Nessim A, Weiss E G, Nogueras J J, Wexner S D. Comparison of laparoscopically assisted and conventional ileocolic resection for Crohn's disease.  Eur J Surg. 2000;  166(3) 213-217
    CrossrefPubMedGoogle Scholar
  • 45 Bemelman W A, Slors J F, Dunker M S et al.. Laparoscopic-assisted vs. open ileocolic resection for Crohn's disease. A comparative study.  Surg Endosc. 2000;  14(8) 721-725
    CrossrefPubMedGoogle Scholar
  • 46 Kishi D, Nezu R, Ito T et al.. Laparoscopic-assisted surgery for Crohn's disease: reduced surgical stress following ileocolectomy.  Surg Today. 2000;  30(3) 219-222
    CrossrefPubMedGoogle Scholar
  • 47 Diamond I R, Langer J C. Laparoscopic-assisted versus open ileocolic resection for adolescent Crohn disease.  J Pediatr Gastroenterol Nutr. 2001;  33(5) 543-547
    CrossrefPubMedGoogle Scholar
  • 48 Benoist S, Panis Y, Beaufour A, Bouhnik Y, Matuchansky C, Valleur P. Laparoscopic ileocecal resection in Crohn's disease: a case-matched comparison with open resection.  Surg Endosc. 2003;  17(5) 814-818
    CrossrefPubMedGoogle Scholar
  • 49 Shore G, Gonzalez Q H, Bondora A, Vickers S M. Laparoscopic vs conventional ileocolectomy for primary Crohn disease.  Arch Surg. 2003;  138(1) 76-79
    PubMedGoogle Scholar
  • 50 von Allmen D, Markowitz J E, York A, Mamula P, Shepanski M, Baldassano R. Laparoscopic-assisted bowel resection offers advantages over open surgery for treatment of segmental Crohn's disease in children.  J Pediatr Surg. 2003;  38(6) 963-965
    CrossrefPubMedGoogle Scholar
  • 51 Bergamaschi R, Pessaux P, Arnaud J P. Comparison of conventional and laparoscopic ileocolic resection for Crohn's disease.  Dis Colon Rectum. 2003;  46(8) 1129-1133
    CrossrefPubMedGoogle Scholar
  • 52 Huilgol R L, Wright C M, Solomon M J. Laparoscopic versus open ileocolic resection for Crohn's disease.  J Laparoendosc Adv Surg Tech A. 2004;  14(2) 61-65
    CrossrefPubMedGoogle Scholar
  • 53 Lowney J K, Dietz D W, Birnbaum E H, Kodner I J, Mutch M G, Fleshman J W. Is there any difference in recurrence rates in laparoscopic ileocolic resection for Crohn's disease compared with conventional surgery? A long-term, follow-up study.  Dis Colon Rectum. 2006;  49 58-63
    CrossrefPubMedGoogle Scholar

Benjamin PersonM.D. 

Department of Colorectal Surgery, Cleveland Clinic Florida

2950 Cleveland Clinic Blvd., Weston, FL 33331

Email: personb@ccf.org