Healing was impaired in patients with a high fistula-in-ano or a recto-vaginal fistula preoperatively, faecal contamination, and postoperative perineal sepsis. In the past, the association of anti-TNF therapy before surgery with postoperative complications was controversial, but recent studies and meta-analysis have shown an increased risk of postoperative sepsis, intra-abdominal abscesses, anastomotic leak, wound infections, and readmission in CD patients. In this group of patients, multidisciplinary management is essential to maintain pouch function [EL3]Patients diagnosed with CD after an IPAA have higher complications and failure rates than those with ulcerative colitis. Perforation and bleeding rates are low [2–5%], and no mortality has been reported. An ongoing randomised study compares surgery and medical treatment in patients with short segment ileal disease and may help in treatment selection in the future.In patients with symptomatic perforating/fistulising disease, surgery should be considered at an early stage [EL4]In perforating CD, surgery should be considered at an early stage. Surgery rates of patients who eventually need surgery at 1, 3, and 5 years vary at 13–17%, 28–42%, and 36–42%, respectively. Routine vagotomy is generally contraindicated in Crohn’s patients [EL4]In CD of the antrum and duodenal bulb, stricturoplasty and Roux-en-Y bypass are considered effective surgical options. The most common symptoms are upper abdominal pain, nausea and vomiting, weight loss, diarrhoea, haematemesis. At present, no data are available to determine the safest period of discontinuation before surgery in order to reduce the risk related to anti-TNF therapy.Free perforation with peritonitis and massive haemorrhage unresponsive to other therapies are indications for emergency surgery in CD [EL3]CD can present with acute complications requiring emergency surgery in approximately 6–16% of cases.Patients with CD who require emergency surgery should undergo fluid and electrolytes resuscitation to allow adequate tissue oxygenation before induction of anaesthesia; blood transfusions may be necessary in cases of haemorrhage. It’s an important reminder that you’re not alone in your journey.This U.K. nonprofit is committed to raising awareness about Crohn’s disease, ulcerative colitis, and other kinds of inflammatory bowel disease (IBD). Although the evidence is weak, all of it directs towards better results if anti-TNF therapy and seton placements are combined.The use of cutting setons in perianal CD is not recommended and may result in keyhole deformity and faecal incontinence [EL 3]The use of the cutting seton was already described by Hippocrates in the 5th century BC.
The specificity and sensitivity of both imaging modalities are increased when combined with examination under anaesthetic [EUA] [EL1]. If surgery is required in a malnourished patient, a staged procedure is advised [EL5]Patients who have lost 10% or more of their body mass in a 3-month period are considered significantly malnourished and may benefit from preoperative nutritional support by either enteral or parenteral nutrition.There is no difference between elemental and polymeric enteral diet for preoperative optimisation in adults. Alexa Federico’s diagnosis with Crohn’s disease at age 12 was the inspiration for her future career as a certified nutritional therapy practitioner.
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