Surgical therapy for Crohn's disease of the colon and rectum

Surgical management of Crohn's disease of the colon and rectum is aimed at eliminating or alleviating complications of disease. When Crohn's disease is confined to the colon at initial presentation, prognosis for recurrence will be influenced strongly by the type of surgery performed. Recurrence rates are lowest following total protocolectomy and ileostomy with recurrent disease presenting in the small intestine and highest after segmental colonic resection. Rectum-preserving procedures such as ileorectal anastomosis are appropriate when the rectum is disease free; however, recurrence is common. Reservoir operations for patients with Crohn's colitis are associated with a high rate of pouch failure; however, there are subsets of patients with Crohn's disease and intra-abdominal/pelvic reservoirs who have a satisfactory outcome.