Crohn’s Disease: Surgical Management

  • Roberta MuldoonEmail author
  • Alan J. Herline


Crohn’s disease is a chronic transmural inflammatory condition that primarily affects the terminal ileum and colon; however, it can affect all portions of the gastrointestinal tract. The course that the disease takes is variable, often manifesting acute attacks on a chronic underlying potentially debilitating condition. Though Crohn’s disease, at this time, is not curable, the goal of treatment is to induce and maintain remission of the disease to control symptoms as well as decrease the complications from this disease. This is accomplished primarily through medications; however, surgery plays an important role in the treatment of this disease.


Crohn’s disease Incidence Prevalence Indications Pre-operative evaluations Imaging Operative considerations Nutritional assessment Recurrence 

Supplementary material

Video 49.1

Laparoscopic ileocolic resection (MPG 273514 kb)


  1. 1.
    Leowardi C, Heuschen G, Kienle P, Heuschen U, Schmidt J. Surgical treatment of severe inflammatory bowel diseases. Dig Dis. 2003;21(1):54–62.PubMedGoogle Scholar
  2. 2.
    Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn’s disease: results from observational studies. World J Gastroenterol. 2012;18(15):1723–31.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1785–94.Google Scholar
  4. 4.
    Loftus Jr EV, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology. 1998;114(6):1161–8. Erratum in: Gastroenterology 1999 Jun;116(6):1507.Google Scholar
  5. 5.
    Loftus CG, Loftus Jr EV, Harmsen WS, Zinsmeister AR, Tremaine WJ, Melton 3rd LJ, et al. Update on the incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted County, Minnesota, 1940–2000. Inflamm Bowel Dis. 2007;13(3):254–61.Google Scholar
  6. 6.
    Jacobsen BA, Fallingborg J, Rasmussen HH, Nielsen KR, Drewes AM, Puho E, et al. Increase in incidence and prevalence of inflammatory bowel disease in northern Denmark: a population-based study, 1978–2002. Eur J Gastroenterol Hepatol. 2006;18(6):601–6.PubMedGoogle Scholar
  7. 7.
    Loftus Jr EV, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn’s disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther. 2002;16(1):51–60.PubMedGoogle Scholar
  8. 8.
    Agrez MV, Valente RM, Pierce W, Melton 3rd LJ, van Heerden JA, Beart Jr RW. Surgical history of Crohn’s disease in a well-defined population. Mayo Clin Proc. 1982;57(12):747–52.PubMedGoogle Scholar
  9. 9.
    Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg. 2000;231(1):38–45.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Basilisco G, Campanini M, Cesana B, Ranzi T, Bianchi P. Risk factors for first operation in Crohn’s disease. Am J Gastroenterol. 1989;84(7):749–52.PubMedGoogle Scholar
  11. 11.
    Munkholm P, Langholz E, Davidsen M, Binder V. Intestinal cancer risk and mortality in patients with Crohn’s disease. Gastroenterology. 1993;105(6):1716–23.PubMedGoogle Scholar
  12. 12.
    Farmer RG, Whelan G, Fazio VW. Long-term follow-up of patients with Crohn’s disease. Relationship between the clinical pattern and prognosis. Gastroenterology. 1985;88(6):1818–25.PubMedGoogle Scholar
  13. 13.
    Truelove SC, Pena AS. Course and prognosis of Crohn’s disease. Gut. 1976;17(3):192–201.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Michelassi F, Balestracci T, Chappell R, Block GE. Primary and recurrent Crohn’s disease. Experience with 1379 patients. Ann Surg. 1991;214(3):230–8. discussion 238–40.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Ramadas AV, Gunesh S, Thomas GA, Williams GT, Hawthorne AB. Natural history of Crohn’s disease in a population-based cohort from Cardiff (1986–2003): a study of changes in medical treatment and surgical resection rates. Gut. 2010;59(9):1200–6.PubMedGoogle Scholar
  16. 16.
    Jess T, Riis L, Vind I, Winther KV, Borg S, Binder V, et al. Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen. Denmark Inflamm Bowel Dis. 2007;13(4):481–9.PubMedGoogle Scholar
  17. 17.
    Rungoe C, Langholz E, Andersson M, Basit S, Nielsen NM, Wohlfahrt J, et al. Changes in medical treatment and surgery rates in inflammatory bowel disease: a nationwide cohort study 1979–2011. Gut. 2014;63(10):1607–16.PubMedGoogle Scholar
  18. 18.
    Vester-Andersen MK, Prosberg MV, Jess T, Andersson M, Bengtsson BG, Blixt T, et al. Disease course and surgery rates in inflammatory bowel disease: a population-based, 7-year follow-up study in the era of immunomodulating therapy. Am J Gastroenterol. 2014;109(5):705–14.PubMedGoogle Scholar
  19. 19.
    Peyrin-Biroulet L, Oussalah A, Williet N, Pillot C, Bresler L, Bigard MA. Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn’s disease. Gut. 2011;60(7):930–6.PubMedGoogle Scholar
  20. 20.
    Solberg IC, Vatn MH, Høie O, Stray N, Sauar J, Jahnsen J, IBSEN Study Group, et al. Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007;5(12):1430–8.PubMedGoogle Scholar
  21. 21.
    Sands BE, Arsenault JE, Rosen MJ, Alsahli M, Bailen L, Banks P, et al. Risk of early surgery for Crohn’s disease: implications for early treatment strategies. Am J Gastroenterol. 2003;98(12):2712–8.PubMedGoogle Scholar
  22. 22.
    Picco MF, Zubiaurre I, Adluni M, Cangemi JR, Shelton D. Immunomodulators are associated with a lower risk of first surgery among patients with non-penetrating non-stricturing Crohn’s disease. Am J Gastroenterol. 2009;104(11):2754–9.PubMedGoogle Scholar
  23. 23.
    D’Haens G, Baert F, van Assche G, Caenepeel P, Vergauwe P, Tuynman H, Belgian Inflammatory Bowel Disease Research Group, North-Holland Gut Club, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet. 2008;371(9613):660–7.PubMedGoogle Scholar
  24. 24.
    Peyrin-Biroulet L, Lepage C, Jooste V, Guéant JL, Faivre J, Bouvier AM. Colorectal cancer in inflammatory bowel diseases: a population-based study (1976–2008). Inflamm Bowel Dis. 2012;18(12):2247–51.PubMedGoogle Scholar
  25. 25.
    Burke JP, Velupillai Y, O’Connell PR, Coffey JC. National trends in intestinal resection for Crohn’s disease in the post-biologic era. Int J Colorectal Dis. 2013;28(10):1401–6.PubMedGoogle Scholar
  26. 26.
    Bouguen G, Peyrin-Biroulet L. Surgery for adult Crohn’s disease: what is the actual risk? Gut. 2011;60(9):1178–81.PubMedGoogle Scholar
  27. 27.
    Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F. Prospective study of the features, indications, and surgical treatment in 513 consecutive patients affected by Crohn’s disease. Surgery. 1997;122(4):661–7.PubMedGoogle Scholar
  28. 28.
    Fichera A, Michelassi F. Surgical treatment of Crohn’s disease. J Gastrointest Surg. 2007;11(6):791–803.PubMedGoogle Scholar
  29. 29.
    Faubion Jr WA, Loftus Jr EV, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121(2):255–60.PubMedGoogle Scholar
  30. 30.
    Scott NA, Hughes LE. Timing of ileocolonic resection for symptomatic Crohn’s disease—the patient’s view. Gut. 1994;35(5):656–7.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Alós R, Hinojosa J. Timing of surgery in Crohn’s disease: a key issue in the management. World J Gastroenterol. 2008;14(36):5532–9.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Ajlouni Y, Iser JH, Gibson PR. Endoscopic balloon dilatation of intestinal strictures in Crohn’s disease: safe alternative to surgery. J Gastroenterol Hepatol. 2007;22(4):486–90.PubMedGoogle Scholar
  33. 33.
    Ferlitsch A, Reinisch W, Püspök A, Dejaco C, Schillinger M, Schöfl R, et al. Safety and efficacy of endoscopic balloon dilation for treatment of Crohn’s disease strictures. Endoscopy. 2006;38(5):483–7.PubMedGoogle Scholar
  34. 34.
    Homan WP, Tang CK, Thorbjarnarson B. Acute massive hemorrhage from intestinal Crohn disease. Report of seven cases and review of the literature. Arch Surg. 1976;111(8):901–5.PubMedGoogle Scholar
  35. 35.
    Robert JR, Sachar DB, Greenstein AJ. Severe gastrointestinal hemorrhage in Crohn’s disease. Ann Surg. 1991;213(3):207–11.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Driver CP, Anderson DN, Keenan RA. Massive intestinal bleeding in association with Crohn’s disease. J R Coll Surg Edinb. 1996;41(3):152–4.PubMedGoogle Scholar
  37. 37.
    Cirocco WC, Reilly JC, Rusin LC. Life-threatening hemorrhage and exsanguination from Crohn’s disease. Report of four cases. Dis Colon Rectum. 1995;38(1):85–95.PubMedGoogle Scholar
  38. 38.
    Kostka R, Lukás M. Massive, life-threatening bleeding in Crohn’s disease. Acta Chir Belg. 2005;105(2):168–74.PubMedGoogle Scholar
  39. 39.
    Remzi FH, Dietz DW, Unal E, Levitin A, Sands MJ, Fazio VW. Combined use of preoperative provocative angiography and highly selective methylene blue injection to localize an occult small-bowel bleeding site in a patient with Crohn’s disease: report of a case. Dis Colon Rectum. 2003;46(2):260–3.PubMedGoogle Scholar
  40. 40.
    Nagler SM, Poticha SM. Intraabdominal abscess in regional enteritis. Am J Surg. 1979;137(3):350–4.PubMedGoogle Scholar
  41. 41.
    Steinberg DM, Cooke WT, Alexander-Williams J. Abscess and fistulae in Crohn’s disease. Gut. 1973;14(11):865–69.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Edwards H. Crohn’s disease. An inquiry into its nature and consequences. Ann R Coll Surg Engl. 1969;44(3):121–39.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Greenstein AJ, Sachar DB, Greenstein RJ, Janowitz HD, Aufses Jr AH. Intraabdominal abscess in Crohn’s (ileo) colitis. Am J Surg. 1982;143(6):727–30.PubMedGoogle Scholar
  44. 44.
    Keighley MR, Eastwood D, Ambrose NS, Allan RN, Burdon DW. Incidence and microbiology of abdominal and pelvic abscess in Crohn’s disease. Gastroenterology. 1982;83(6):1271–5.PubMedGoogle Scholar
  45. 45.
    Garcia JC, Persky SE, Bonis PA, Topazian M. Abscesses in Crohn’s disease: outcome of medical versus surgical treatment. J Clin Gastroenterol. 2001;32(5):409–12.PubMedGoogle Scholar
  46. 46.
    Gervais DA, Hahn PF, O’Neill MJ, Mueller PR. Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology. 2002;222(3):645–51. PubMed.PubMedGoogle Scholar
  47. 47.
    Van Patter WN, Bargen JA, Dockerty MB, Feldman WH, Mayo CW, Waugh JM. Regional enteritis. Gastroenterology. 1954;26(3):347–450.PubMedGoogle Scholar
  48. 48.
    Banks BM, Zetzel L, Richter HS. Morbidity and mortality in regional enteritis. Report of 168 cases. Am J Dig Dis. 1969;14(6):369–79.PubMedGoogle Scholar
  49. 49.
    Tassiopoulos AK, Baum G, Halverson JD. Small bowel fistulas. Surg Clin North Am. 1996;76(5):1175–81.PubMedGoogle Scholar
  50. 50.
    Berry SM, Fischer JE. Enterocutaneous fistulas. Curr Probl Surg. 1994;31(6):469–566.PubMedGoogle Scholar
  51. 51.
    Poritz LS, Gagliano GA, McLeod RS, MacRae H, Cohen Z. Surgical management of entero and colocutaneous fistulae in Crohn’s disease: 17 year’s experience. Int J Colorectal Dis. 2004;19(5):481–5.PubMedGoogle Scholar
  52. 52.
    Laukoetter MG, Mennigen R, Hannig CM, Osada N, Rijcken E, Vowinkel T, et al. Intestinal cancer risk in Crohn’s disease: a meta-analysis. J Gastrointest Surg. 2011;15(4):576–83.PubMedGoogle Scholar
  53. 53.
    Canavan C, Abrams KR, Mayberry J. Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn’s disease. Aliment Pharmacol Ther. 2006;23(8):1097–104.PubMedGoogle Scholar
  54. 54.
    von Roon AC, Reese G, Teare J, Constantinides V, Darzi AW, Tekkis PP. The risk of cancer in patients with Crohn’s disease. Dis Colon Rectum. 2007;50(6):839–55.Google Scholar
  55. 55.
    Ribeiro MB, Greenstein AJ, Sachar DB, Barth J, Balasubramanian S, Harpaz N, et al. Colorectal adenocarcinoma in Crohn’s disease. Ann Surg. 1996;223(2):186–93.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Michelassi F, Testa G, Pomidor WJ, Lashner BA, Block GE. Adenocarcinoma complicating Crohn’s disease. Dis Colon Rectum. 1993;36(7):654–61.PubMedGoogle Scholar
  57. 57.
    Richards ME, Rickert RR, Nance FC. Crohn’s disease-associated carcinoma. A poorly recognized complication of inflammatory bowel disease. Ann Surg. 1989;209(6):764–73.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Lovasz BD, Lakatos L, Golovics PA, David G, Pandur T, Erdelyi Z, et al. Risk of colorectal cancer in Crohn’s disease patients with colonic involvement and stenosing disease in a population-based cohort from Hungary. J Gastrointestin Liver Dis. 2013;22(3):265–8.PubMedGoogle Scholar
  59. 59.
    Kiran RP, Nisar PJ, Goldblum JR, Fazio VW, Remzi FH, Shen B, et al. Dysplasia associated with Crohn’s colitis: segmental colectomy or more extended resection? Ann Surg. 2012;256(2):221–6.PubMedGoogle Scholar
  60. 60.
    Simpson S, Traube J, Riddell RH. The histologic appearance of dysplasia (precarcinomatous change) in Crohn’s disease of the small and large intestine. Gastroenterology. 1981;81(3):492–501.PubMedGoogle Scholar
  61. 61.
    Riddell RH, Goldman H, Ransohoff DF, Appelman HD, Fenoglio CM, Haggitt RC, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol. 1983;14(11):931–68.PubMedGoogle Scholar
  62. 62.
    SC T, LJ W. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041–8.Google Scholar
  63. 63.
    Jalan KN, Sircus W, Card WI, Falconer CW, Bruce CB, Crean GP, et al. An experience of ulcerative colitis. I. Toxic dilation in 55 cases. Gastroenterology. 1969;57(1):68–82.PubMedGoogle Scholar
  64. 64.
    Gulliford SR, Limdi JK. Acute severe ulcerative colitis: timing is everything. Postgrad Med J. 2011;87(1025):215–22.PubMedGoogle Scholar
  65. 65.
    McIntyre PB, Powell-Tuck J, Wood SR, Lennard-Jones JE, Lerebours E, Hecketsweiler P, et al. Controlled trial of bowel rest in the treatment of severe acute colitis. Gut. 1986;27(5):481–5.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Dickinson RJ, Ashton MG, Axon AT, Smith RC, Yeung CK, Hill GL. Controlled trial of intravenous hyperalimentation and total bowel rest as an adjunct to the routine therapy of acute colitis. Gastroenterology. 1980;79(6):1199–204.PubMedGoogle Scholar
  67. 67.
    Chapman RW, Selby WS, Jewell DP. Controlled trial of intravenous metronidazole as an adjunct to corticosteroids in severe ulcerative colitis. Gut. 1986;27(10):1210–2.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Mantzaris GJ, Petraki K, Archavlis E, Amberiadis P, Kourtessas D, Christidou A, et al. A prospective randomized controlled trial of intravenous ciprofloxacin as an adjunct to corticosteroids in acute, severe ulcerative colitis. Scand J Gastroenterol. 2001;36(9):971–4.PubMedGoogle Scholar
  69. 69.
    Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American college of gastroenterology, practice parameters committee. Am J Gastroenterol. 2010;105(3):501–23.PubMedGoogle Scholar
  70. 70.
    Lees CW, Heys D, Ho GT, Noble CL, Shand AG, Mowat C, Scottish Society of Gastroenterology Infliximab Group, et al. A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2007;26(3):411–9.PubMedGoogle Scholar
  71. 71.
    Järnerot G, Hertervig E, Friis-Liby I, Blomquist L, Karlén P, Grännö C, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology. 2005;128(7):1805–11.PubMedGoogle Scholar
  72. 72.
    Kohn A, Daperno M, Armuzzi A, Cappello M, Biancone L, Orlando A, et al. Infliximab in severe ulcerative colitis: short-term results of different infusion regimens and long-term follow-up. Aliment Pharmacol Ther. 2007;26(5):747–56.PubMedGoogle Scholar
  73. 73.
    Bartels SA, Gardenbroek TJ, Bos L, Ponsioen CY, D’Haens GR, Tanis PJ, et al. Prolonged preoperative hospital stay is a risk factor for complications after emergency colectomy for severe colitis. Colorectal Dis. 2013;15(11):1392–8.PubMedGoogle Scholar
  74. 74.
    Sheth SG, LaMont JT. Toxic megacolon. Lancet. 1998;351(9101):509–13.PubMedGoogle Scholar
  75. 75.
    Heppell J, Farkouh E, Dubé S, Péloquin A, Morgan S, Bernard D. Toxic megacolon. An analysis of 70 cases. Dis Colon Rectum. 1986;29(12):789–92.PubMedGoogle Scholar
  76. 76.
    Harling H, Hegnhøj J, Rasmussen TN, Jarnum S. Fate of the rectum after colectomy and ileostomy for Crohn’s colitis. Dis Colon Rectum. 1991;34(10):931–5.PubMedGoogle Scholar
  77. 77.
    Park MJ, Lim JS. Computed tomography enterography for evaluation of inflammatory bowel disease. Clin Endosc. 2013;46(4):327–66.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Booya F, Fletcher JG, Huprich JE, Barlow JM, Johnson CD, Fidler JL, et al. Active Crohn disease: CT findings and interobserver agreement for enteric phase CT enterography. Radiology. 2006;241(3):787–95.PubMedGoogle Scholar
  79. 79.
    Lee SS, Kim AY, Yang SK, Chung JW, Kim SY, Park SH, Ha HK. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. 2009;251(3):751–61.PubMedGoogle Scholar
  80. 80.
    Masselli G, Gualdi G. CT and MR enterography in evaluating small bowel diseases: when to use which modality? Abdom Imaging. 2013;38(2):249–59. doi: 10.1007/s00261-012-9961-8.CrossRefPubMedGoogle Scholar
  81. 81.
    Jensen MD, Kjeldsen J, Rafaelsen SR, Nathan T. Diagnostic accuracies of MR enterography and CT enterography in symptomatic Crohn’s disease. Scand J Gastroenterol. 2011;46(12):1449–57.PubMedGoogle Scholar
  82. 82.
    Seastedt KP, Trencheva K, Michelassi F, Alsaleh D, Milsom JW, Sonoda T, et al. Accuracy of CT enterography and magnetic resonance enterography imaging to detect lesions preoperatively in patients undergoing surgery for Crohn’s disease. Dis Colon Rectum. 2014;57(12):1364–70.PubMedGoogle Scholar
  83. 83.
    Windsor JA, Hill GL. Protein depletion and surgical risk. Aust N Z J Surg. 1988;58(9):711–5.PubMedGoogle Scholar
  84. 84.
    Parekh NR, Steiger E. Percentage of weight loss as a predictor of surgical risk: from the time of Hiram Studley to today. Nutr Clin Pract. 2004;19(5):471–6.PubMedGoogle Scholar
  85. 85.
    Rombeau JL, Barot LR, Williamson CE, Mullen JL. Preoperative total parenteral nutrition and surgical outcome in patients with inflammatory bowel disease. Am J Surg. 1982;143(1):139–43.PubMedGoogle Scholar
  86. 86.
    Studley HO. Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. 1936. Nutr Hosp. 2001;16(4):141–3.PubMedGoogle Scholar
  87. 87.
    Seltzer MH, Slocum BA, Cataldi-Betcher EL, Fileti C, Gerson N. Instant nutritional assessment: absolute weight loss and surgical mortality. JPEN J Parenter Enteral Nutr. 1982;6(3):218–21.PubMedGoogle Scholar
  88. 88.
    Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134(1):36–42.PubMedGoogle Scholar
  89. 89.
    Lindor KD, Fleming CR, Ilstrup DM. Preoperative nutritional status and other factors that influence surgical outcome in patients with Crohn’s disease. Mayo Clin Proc. 1985;60(6):393–6.PubMedGoogle Scholar
  90. 90.
    Triantafillidis JK, Papalois AE. The role of total parenteral nutrition in inflammatory bowel disease: current aspects. Scand J Gastroenterol. 2014;49(1):3–14.PubMedGoogle Scholar
  91. 91.
    Shiloni E, Coronado E, Freund HR. Role of total parenteral nutrition in the treatment of Crohn’s disease. Am J Surg. 1989;157(1):180–5.PubMedGoogle Scholar
  92. 92.
    Lerebours E, Messing B, Chevalier B, Bories C, Colin R, Bernier JJ. An evaluation of total parenteral nutrition in the management of steroid-dependent and steroid-resistant patients with Crohn’s disease. JPEN J Parenter Enteral Nutr. 1986;10(3):274–8.PubMedGoogle Scholar
  93. 93.
    Müller JM, Keller HW, Erasmi H, Pichlmaier H. Total parenteral nutrition as the sole therapy in Crohn’s disease—a prospective study. Br J Surg. 1983;70(1):40–3.PubMedGoogle Scholar
  94. 94.
    Greenberg GR, Fleming CR, Jeejeebhoy KN, Rosenberg IH, Sales D, Tremaine WJ. Controlled trial of bowel rest and nutritional support in the management of Crohn’s disease. Gut. 1988;29(10):1309–15.PubMedPubMedCentralGoogle Scholar
  95. 95.
    Jacobson S. Early postoperative complications in patients with Crohn’s disease given and not given preoperative total parenteral nutrition. Scand J Gastroenterol. 2012;47(2):170–7.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Lashner BA, Evans AA, Hanauer SB. Preoperative total parenteral nutrition for bowel resection in Crohn’s disease. Dig Dis Sci. 1989;34(5):741–6.PubMedGoogle Scholar
  97. 97.
    No Authors Listed. Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med. 1991;325(8):525–32.Google Scholar
  98. 98.
    Pettigrew RA, Hill GL. Indicators of surgical risk and clinical judgement. Br J Surg. 1986;73(1):47–51.PubMedGoogle Scholar
  99. 99.
    Candy S, Wright J, Gerber M, Adams G, Gerig M, Goodman R. A controlled double blind study of azathioprine in the management of Crohn’s disease. Gut. 1995;37(5):674–8.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Markowitz J, Grancher K, Kohn N, Lesser M, Daum F. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease. Gastroenterology. 2000;119(4):895–902.PubMedGoogle Scholar
  101. 101.
    Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Braakman T, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med. 1997;337(15):1029–35.PubMedGoogle Scholar
  102. 102.
    Aszodi A, Ponsky JL. Effects of corticosteroid on the healing bowel anastomosis. Am Surg. 1984;50(10):546–8.PubMedGoogle Scholar
  103. 103.
    Furst MB, Stromberg BV, Blatchford GJ, Christensen MA, Thorson AG. Colonic anastomoses: bursting strength after corticosteroid treatment. Dis Colon Rectum. 1994;37(1):12–5.PubMedGoogle Scholar
  104. 104.
    Ehrlich HP, Hunt TK. Effects of cortisone and vitamin A on wound healing. Ann Surg. 1968;167(3):324–8.PubMedPubMedCentralGoogle Scholar
  105. 105.
    Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989;11(6):954–63.PubMedGoogle Scholar
  106. 106.
    Subramanian V, Saxena S, Kang JY, Pollok RC. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol. 2008;103(9):2373–81.PubMedGoogle Scholar
  107. 107.
    Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR. Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology. 2003;125(2):320–7.Google Scholar
  108. 108.
    Bruewer M, Utech M, Rijcken EJ, Anthoni C, Laukoetter MG, Kersting S, et al. Preoperative steroid administration: effect on morbidity among patients undergoing intestinal bowel resection for Crohn’s disease. World J Surg. 2003;27(12):1306–10.PubMedGoogle Scholar
  109. 109.
    Mascarenhas C, Nunoo R, Asgeirsson T, Rivera R, Kim D, Hoedema R, et al. Outcomes of ileocolic resection and right hemicolectomies for Crohn’s patients in comparison with non-Crohn’s patients and the impact of perioperative immunosuppressive therapy with biologics and steroids on inpatient complications. Am J Surg. 2012;203(3):375–8.PubMedGoogle Scholar
  110. 110.
    Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L. Perioperative treatment with infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg. 2008;12(10):1730–6. discussion 1736–7.PubMedGoogle Scholar
  111. 111.
    Colombel JF, Loftus Jr EV, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99(5):878–83.PubMedGoogle Scholar
  112. 112.
    Bafford AC, Powers S, Ha C, Kruse D, Gorfine SR, Chessin DB, et al. Immunosuppressive therapy does not increase operative morbidity in patients with Crohn’s disease. J Clin Gastroenterol. 2013;47(6):491–5.PubMedGoogle Scholar
  113. 113.
    Marchal L, D’Haens G, Van Assche G, Vermeire S, Noman M, Ferrante M, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther. 2004;19(7):749–54.PubMedGoogle Scholar
  114. 114.
    Appau KA, Fazio VW, Shen B, Church JM, Lashner B, Remzi F, et al. Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn’s patients. J Gastrointest Surg. 2008;12(10):1738–44.PubMedGoogle Scholar
  115. 115.
    Ahmed Ali U, Martin ST, Rao AD, Kiran RP. Impact of preoperative immunosuppressive agents on postoperative outcomes in Crohn’s disease. Dis Colon Rectum. 2014;57(5):663–74.PubMedGoogle Scholar
  116. 116.
    Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2011;9, CD004320.Google Scholar
  117. 117.
    He X, Chen Z, Huang J, Lian L, Rouniyar S, Wu X, Lan P. Stapled side-to-side anastomosis might be better than handsewn end-to-end anastomosis in ileocolic resection for Crohn’s disease: a meta-analysis. Dig Dis Sci. 2014;59(7):1544–51.PubMedGoogle Scholar
  118. 118.
    Yamamoto T, Bain IM, Mylonakis E, Allan RN, Keighley MR. Stapled functional end-to-end anastomosis versus sutured end-to-end anastomosis after ileocolonic resection in Crohn disease. Scand J Gastroenterol. 1999;34(7):708–13.PubMedGoogle Scholar
  119. 119.
    Resegotti A, Astegiano M, Farina EC, Ciccone G, Avagnina G, Giustetto A, et al. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn’s disease surgery. Dis Colon Rectum. 2005;48(3):464–8.PubMedGoogle Scholar
  120. 120.
    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(5):493–6.PubMedGoogle Scholar
  121. 121.
    Simillis C, Purkayastha S, Yamamoto T, Strong SA, Darzi AW, Tekkis PP. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum. 2007;50(10):1674–87.PubMedGoogle Scholar
  122. 122.
    McLeod RS, Wolff BG, Ross S, Parkes R, McKenzie M, Investigators of the CAST Trial. Recurrence of Crohn’s disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum. 2009;52(5):919–27.PubMedGoogle Scholar
  123. 123.
    Vangeenberghe N, De Vogelaere K, Haentjens P, Delvaux G. Laparoscopically assisted ileocolectomy in patients with Crohn’s disease: a study of 50 consecutive patients. Surg Endosc. 2009;23(8):1797–801.PubMedGoogle Scholar
  124. 124.
    Soop M, Larson DW, Malireddy K, Cima RR, Young-Fadok TM, Dozois EJ. Safety, feasibility, and short-term outcomes of laparoscopically assisted primary ileocolic resection for Crohn’s disease. Surg Endosc. 2009;23(8):1876–81.PubMedGoogle Scholar
  125. 125.
    Reissman P, Salky BA, Pfeifer J, Edye M, Jagelman DG, Wexner SD. Laparoscopic surgery in the management of inflammatory bowel disease. Am J Surg. 1996;171(1):47–50.PubMedGoogle Scholar
  126. 126.
    Reissman P, Salky BA, Edye M, Wexner SD. Laparoscopic surgery in Crohn’s disease. Indications and results. Surg Endosc. 1996;10(12):1201–3.PubMedGoogle Scholar
  127. 127.
    Tabet J, Hong D, Kim CW, Wong J, Goodacre R, Anvari M. Laparoscopic versus open bowel resection for Crohn’s disease. Can J Gastroenterol. 2001;15(4):237–42.PubMedGoogle Scholar
  128. 128.
    Duepree HJ, Senagore AJ, Delaney CP, Brady KM, Fazio VW. Advantages of laparoscopic resection for ileocecal Crohn’s disease. Dis Colon Rectum. 2002;45(5):605–10.PubMedGoogle Scholar
  129. 129.
    Bergamaschi R, Pessaux P, Arnaud JP. Comparison of conventional and laparoscopic ileocolic resection for Crohn’s disease. Dis Colon Rectum. 2003;46(8):1129–33.PubMedGoogle Scholar
  130. 130.
    Luan X, Gross E. Laparoscopic assisted surgery for Crohn’s disease an initial experience and results. J Tongji Med Univ. 2000;20(4):332–5.PubMedGoogle Scholar
  131. 131.
    Umanskiy K, Malhotra G, Chase A, Rubin MA, Hurst RD, Fichera A. Laparoscopic colectomy for Crohn’s colitis. A large prospective comparative study. J Gastrointest Surg. 2010;14(4):658–63.PubMedGoogle Scholar
  132. 132.
    Rosman AS, Melis M, Fichera A. Metaanalysis of trials comparing laparoscopic and open surgery for Crohn’s disease. Surg Endosc. 2005;19(12):1549–55.PubMedGoogle Scholar
  133. 133.
    Tan JJ, Tjandra JJ. Laparoscopic surgery for Crohn’s disease: a meta-analysis. Dis Colon Rectum. 2007;50(5):576–85.PubMedGoogle Scholar
  134. 134.
    Milsom JW, Hammerhofer KA, Böhm B, Marcello P, Elson P, Fazio VW. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum. 2001;44(1):1–8.PubMedGoogle Scholar
  135. 135.
    Maartense S, Dunker MS, Slors JF, Cuesta MA, Pierik EG, Gouma DJ, et al. Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg. 2006;243(2):143–9.PubMedPubMedCentralGoogle Scholar
  136. 136.
    Goyer P, Alves A, Bretagnol F, Bouhnik Y, Valleur P, Panis Y. Impact of complex Crohn’s disease on the outcome of laparoscopic ileocecal resection: a comparative clinical study in 124 patients. Dis Colon Rectum. 2009;52(2):205–10.PubMedGoogle Scholar
  137. 137.
    Schmidt CM, Talamini MA, Kaufman HS, Lilliemoe KD, Learn P, Bayless T. Laparoscopic surgery for Crohn’s disease: reasons for conversion. Ann Surg. 2001;233(6):733–9.PubMedPubMedCentralGoogle Scholar
  138. 138.
    Drenick EJ, Ament ME, Finegold SM, Corrodi P, Passaro E. Bypass enteropathy. Intestinal and systemic manifestations following small-bowel bypass. JAMA. 1976;236(3):269–72.PubMedGoogle Scholar
  139. 139.
    Frank JD, Shorey BA. Adenocarcinoma of the small bowel as a complication of Crohn’s disease. Gut. 1973;14(2):120–4.PubMedPubMedCentralGoogle Scholar
  140. 140.
    Hawker PC, Gyde SN, Thompson H, Allan RN. Adenocarcinoma of the small intestine complicating Crohn’s disease. Gut. 1982;23(3):188–93.PubMedPubMedCentralGoogle Scholar
  141. 141.
    Fazio VW, Marchetti F, Church M, Goldblum JR, Lavery C, Hull TL, 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(4):563–71.PubMedPubMedCentralGoogle Scholar
  142. 142.
    Tichansky D, Cagir B, Yoo E, Marcus SM, Fry RD. Strictureplasty for Crohn’s disease: meta-analysis. Dis Colon Rectum. 2000;43(7):911–9.PubMedGoogle Scholar
  143. 143.
    Ambe R, Campbell L, Cagir B. A comprehensive review of strictureplasty techniques in Crohn’s disease: types, indications, comparisons, and safety. J Gastrointest Surg. 2012;16(1):209–17.PubMedGoogle Scholar
  144. 144.
    Michelassi F. Side-to-side isoperistaltic strictureplasty for multiple Crohn’s strictures. Dis Colon Rectum. 1996;39(3):345–9.PubMedGoogle Scholar
  145. 145.
    Poggioli G, Stocchi L, Laureti S, Selleri S, Marra C, Magalotti C, et al. Conservative surgical management of terminal ileitis: side-to-side enterocolic anastomosis. Dis Colon Rectum. 1997;40(2):234–7.PubMedGoogle Scholar
  146. 146.
    Poggioli G, Laureti S, Pierangeli F, Ugolini F. A new model of strictureplasty for multiple and long stenoses in Crohn’s ileitis: side-to-side diseased to disease-free anastomosis. Dis Colon Rectum. 2003;46(1):127–30.PubMedGoogle Scholar
  147. 147.
    Roy P, Kumar D. Strictureplasty for active Crohn’s disease. Int J Colorectal Dis. 2006;21(5):427–32.PubMedGoogle Scholar
  148. 148.
    Ozuner G, Fazio VW, Lavery IC, Milsom JW, Strong SA. Reoperative rates for Crohn’s disease following strictureplasty. Long-term analysis. Dis Colon Rectum. 1996;39(11):1199–203.PubMedGoogle Scholar
  149. 149.
    Tonelli F, Fedi M, Paroli GM, Fazi M. Indications and results of side-to-side isoperistaltic strictureplasty in Crohn’s disease. Dis Colon Rectum. 2004;47(4):494–501.PubMedGoogle Scholar
  150. 150.
    Stebbing JF, Jewell DP, Kettlewell MG, Mortensen NJ. Recurrence and reoperation after strictureplasty for obstructive Crohn’s disease: long-term results [corrected]. Br J Surg. 1995;82(11):1471–4.PubMedGoogle Scholar
  151. 151.
    Dietz DW, Fazio VW, Laureti S, Strong SA, Hull TL, Church J, et al. Strictureplasty in diffuse Crohn’s jejunoileitis: safe and durable. Dis Colon Rectum. 2002;45(6):764–70.PubMedGoogle Scholar
  152. 152.
    Yamamoto T, Fazio VW, Tekkis PP. Safety and efficacy of strictureplasty for Crohn’s disease: a systematic review and meta-analysis. Dis Colon Rectum. 2007;50(11):1968–86.PubMedGoogle Scholar
  153. 153.
    Hurst RD, Michelassi F. Strictureplasty for Crohn’s disease: techniques and long-term results. World J Surg. 1998;22(4):359–63.PubMedGoogle Scholar
  154. 154.
    Sampietro GM, Cristaldi M, Maconi G, Parente F, Sartani A, Ardizzone S, et al. A prospective, longitudinal study of nonconventional strictureplasty in Crohn’s disease. J Am Coll Surg. 2004;199(1):8–20.PubMedGoogle Scholar
  155. 155.
    Chardavoyne R, Flint GW, Pollack S, Wise L. Factors affecting recurrence following resection for Crohn’s disease. Dis Colon Rectum. 1986;29(8):495–502.PubMedGoogle Scholar
  156. 156.
    Whelan G, Farmer RG, Fazio VW, Goormastic M. Recurrence after surgery in Crohn’s disease. Relationship to location of disease (clinical pattern) and surgical indication. Gastroenterology. 1985;88(6):1826–33.PubMedGoogle Scholar
  157. 157.
    Tjandra JJ, Fazio VW, Lavery IC. Results of multiple strictureplasties in diffuse Crohn’s disease of the small bowel. Aust N Z J Surg. 1993;63(2):95–9.PubMedGoogle Scholar
  158. 158.
    Yamamoto T, Keighley MR. Proctocolectomy is associated with a higher complication rate but carries a lower recurrence rate than total colectomy and ileorectal anastomosis in Crohn colitis. Scand J Gastroenterol. 1999;34(12):1212–5.PubMedGoogle Scholar
  159. 159.
    Longo WE, Oakley JR, Lavery IC, Church JM, Fazio VW. Outcome of ileorectal anastomosis for Crohn’s colitis. Dis Colon Rectum. 1992;35(11):1066–71.PubMedGoogle Scholar
  160. 160.
    Steinberg DM, Allan RN, Cooke WT, Alexander-Williams J. The place of ileorectal anastomosis in Crohn’s disease. Aust N Z J Surg. 1976;46(1):49–54.PubMedGoogle Scholar
  161. 161.
    Ambrose NS, Keighley MR, Alexander-Williams J, Allan RN. Clinical impact of colectomy and ileorectal anastomosis in the management of Crohn’s disease. Gut. 1984;25(3):223–7.PubMedPubMedCentralGoogle Scholar
  162. 162.
    Cooper JC, Jones D, Williams NS. Outcome of colectomy and ileorectal anastomosis in Crohn’s disease. Ann R Coll Surg Engl. 1986;68(5):279–82.PubMedPubMedCentralGoogle Scholar
  163. 163.
    O’Riordan JM, O’Connor BI, Huang H, Victor JC, Gryfe R, MacRae HM, et al. Long-term outcome of colectomy and ileorectal anastomosis for Crohn’s colitis. Dis Colon Rectum. 2011;54(11):1347–54.PubMedGoogle Scholar
  164. 164.
    Cattan P, Bonhomme N, Panis Y, Lémann M, Coffin B, Bouhnik Y, et al. Fate of the rectum in patients undergoing total colectomy for Crohn’s disease. Br J Surg. 2002;89(4):454–9.PubMedGoogle Scholar
  165. 165.
    Chevalier JM, Jones DJ, Ratelle R, Frileux P, Tiret E, Parc R. Colectomy and ileorectal anastomosis in patients with Crohn’s disease. Br J Surg. 1994;81(9):1379–81.PubMedGoogle Scholar
  166. 166.
    Buchmann P, Weterman IT, Keighley MR, Peña SA, Allan RN, Alexander-Williams J. The prognosis of ileorectal anastomosis in Crohn’s disease. Br J Surg. 1981;68(1):7–10.PubMedGoogle Scholar
  167. 167.
    Lock MR, Fazio VW, Farmer RG, Jagelman DG, Lavery IC, Weakley FL. Proximal recurrence and the fate of the rectum following excisional surgery for Crohn’s disease of the large bowel. Ann Surg. 1981;194(6):754–60.PubMedPubMedCentralGoogle Scholar
  168. 168.
    Polle SW, Slors JF, Weverling GJ, Gouma DJ, Hommes DW, Bemelman WA. Recurrence after segmental resection for colonic Crohn’s disease. Br J Surg. 2005;92(9):1143–9.PubMedGoogle Scholar
  169. 169.
    Andersson P, Olaison G, Hallböök O, Sjödahl R. Segmental resection or subtotal colectomy in Crohn’s colitis? Dis Colon Rectum. 2002;45(1):47–53.PubMedPubMedCentralGoogle Scholar
  170. 170.
    Prabhakar LP, Laramee C, Nelson H, Dozois RR. Avoiding a stoma: role for segmental or abdominal colectomy in Crohn’s colitis. Dis Colon Rectum. 1997;40(1):71–8.PubMedGoogle Scholar
  171. 171.
    Korelitz BI, Taunk R, Kesar V. Segmental sigmoid polyposis as a colonoscopic indicator of an ileosigmoid fistula in Crohn’s ileitis. J Crohns Colitis. 2015;9(4):339–41.Google Scholar
  172. 172.
    Yamamoto T, Bain IM, Allan RN, Keighley MR. Persistent perineal sinus after proctocolectomy for Crohn’s disease. Dis Colon Rectum. 1999;42(1):96–101.PubMedGoogle Scholar
  173. 173.
    Keighley MR, Allan RN. Current status and influence of operation on perianal Crohn’s disease. Int J Colorectal Dis. 1986;1(2):104–7.PubMedGoogle Scholar
  174. 174.
    Corman ML, Veidenheimer MC, Coller JA, Ross VH. Perineal wound healing after proctectomy for inflammatory bowel disease. Dis Colon Rectum. 1978;21(3):155–9.PubMedGoogle Scholar
  175. 175.
    Hurst RD, Gottlieb LJ, Crucitti P, Melis M, Rubin M, Michelassi F. Primary closure of complicated perineal wounds with myocutaneous and fasciocutaneous flaps after proctectomy for Crohn’s disease. Surgery. 2001;130(4):767–72.PubMedGoogle Scholar
  176. 176.
    Genua JC, Vivas DA. Management of nonhealing perineal wounds. Clin Colon Rectal Surg. 2007;20(4):322–8.PubMedPubMedCentralGoogle Scholar
  177. 177.
    Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease. Gastroenterology. 1990;99(4):956–63.PubMedGoogle Scholar
  178. 178.
    Olaison G, Smedh K, Sjödahl R. Natural course of Crohn’s disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut. 1992;33(3):331–5.PubMedPubMedCentralGoogle Scholar
  179. 179.
    Frolkis AD, Lipton DS, Fiest KM, Negrón ME, Dykeman J, deBruyn J, et al. Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-analysis of population-based studies. Am J Gastroenterol. 2014;109(11):1739–48.PubMedGoogle Scholar
  180. 180.
    Lennard-Jones JE, Stalder GA. Prognosis after resection of chronic regional ileitis. Gut. 1967;8(4):332–6.PubMedPubMedCentralGoogle Scholar
  181. 181.
    Riss S, Schuster I, Papay P, Mittlböck M, Stift A. Repeat intestinal resections increase the risk of recurrence of Crohn’s disease. Dis Colon Rectum. 2013;56(7):881–7.PubMedGoogle Scholar
  182. 182.
    Avidan B, Sakhnini E, Lahat A, Lang A, Koler M, Zmora O, et al. Risk factors regarding the need for a second operation in patients with Crohn’s disease. Digestion. 2005;72(4):248–53.PubMedGoogle Scholar
  183. 183.
    Reese GE, Nanidis T, Borysiewicz C, Yamamoto T, Orchard T, Tekkis PP. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis. 2008;23(12):1213–21.PubMedGoogle Scholar
  184. 184.
    Yamamoto T, Watanabe T. Strategies for the prevention of postoperative recurrence of Crohn’s disease. Colorectal Dis. 2013;15(12):1471–80.PubMedGoogle Scholar
  185. 185.
    Simillis C, Yamamoto T, Reese GE, Umegae S, Matsumoto K, Darzi AW, et al. A meta-analysis comparing incidence of recurrence and indication for reoperation after surgery for perforating versus nonperforating Crohn’s disease. Am J Gastroenterol. 2008;103(1):196–205.PubMedGoogle Scholar
  186. 186.
    Lautenbach E, Berlin JA, Lichtenstein GR. Risk factors for early postoperative recurrence of Crohn’s disease. Gastroenterology. 1998;115(2):259–67.PubMedGoogle Scholar
  187. 187.
    Buisson A, Chevaux JB, Bommelaer G, Peyrin-Biroulet L. Diagnosis, prevention and treatment of postoperative Crohn’s disease recurrence. Dig Liver Dis. 2012;44(6):453–60.PubMedGoogle Scholar
  188. 188.
    El-Hachem S, Regueiro M. Postoperative Crohn’s disease: prevention and treatment. Expert Rev Gastroenterol Hepatol. 2009;3(3):249–56.PubMedGoogle Scholar
  189. 189.
    Brignola C, Cottone M, Pera A, Ardizzone S, Scribano ML, De Franchis R, et al. Mesalamine in the prevention of endoscopic recurrence after intestinal resection for Crohn’s disease. Italian Cooperative Study Group. Gastroenterology. 1995;108(2):345–9.PubMedGoogle Scholar
  190. 190.
    Singh S, Garg SK, Pardi DS, Wang Z, Murad MH, Loftus Jr EV. Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn’s disease after surgery: a systematic review and network meta-analysis. Gastroenterology. 2015;148(1):64–76.Google Scholar
  191. 191.
    Doherty G, Bennett G, Patil S, Cheifetz A, Moss AC. Interventions for prevention of post-operative recurrence of Crohn’s disease. Cochrane Database Syst Rev. 2009;4, CD006873.Google Scholar
  192. 192.
    Cottone M, Cammà C. Mesalamine and relapse prevention in Crohn’s disease. Gastroenterology. 2000;119(2):597.PubMedGoogle Scholar
  193. 193.
    Lochs H, Mayer M, Fleig WE, Mortensen PB, Bauer P, Genser D, et al. Prophylaxis of postoperative relapse in Crohn’s disease with mesalamine: European Cooperative Crohn’s Disease Study VI. Gastroenterology. 2000;118(2):264–73.PubMedGoogle Scholar
  194. 194.
    Rutgeerts P, Hiele M, Geboes K, Peeters M, Penninckx F, Aerts R, et al. Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology. 1995;108(6):1617–21.PubMedGoogle Scholar
  195. 195.
    Rutgeerts P, Van Assche G, Vermeire S, D’Haens G, Baert F, Noman M, et al. Ornidazole for prophylaxis of postoperative Crohn’s disease recurrence: a randomized, double-blind, placebo-controlled trial. Gastroenterology. 2005;128(4):856–61.PubMedGoogle Scholar
  196. 196.
    Markowitz J. Can we change the natural history of Crohn’s disease with early immunomodulation? Dig Dis. 2014;32(4):345–50.PubMedGoogle Scholar
  197. 197.
    van Loo ES, Vosseberg NW, van der Heide F, Pierie JP, van der Linde K, Ploeg RJ, et al. Thiopurines are associated with a reduction in surgical re-resections in patients with Crohn’s disease: a long-term follow-up study in a regional and academic cohort. Inflamm Bowel Dis. 2013;19(13):2801–8.PubMedGoogle Scholar
  198. 198.
    Domènech E, Mañosa M, Bernal I, Garcia-Planella E, Cabré E, Piñol M, et al. Impact of azathioprine on the prevention of postoperative Crohn’s disease recurrence: results of a prospective, observational, long-term follow-up study. Inflamm Bowel Dis. 2008;14(4):508–13.PubMedGoogle Scholar
  199. 199.
    Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, ACCENT I Study Group, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359(9317):1541–9.PubMedGoogle Scholar
  200. 200.
    Savarino E, Bodini G, Dulbecco P, Assandri L, Bruzzone L, Mazza F, Frigo AC, et al. Adalimumab is more effective than azathioprine and mesalamine at preventing postoperative recurrence of Crohn’s disease: a randomized controlled trial. Am J Gastroenterol. 2013;108(11):1731–42.PubMedGoogle Scholar
  201. 201.
    Regueiro M, Schraut W, Baidoo L, Kip KE, Sepulveda AR, Pesci M, et al. Infliximab prevents Crohn’s disease recurrence after ileal resection. Gastroenterology. 2009;136(2):441–50.PubMedGoogle Scholar
  202. 202.
    Yoshida K, Fukunaga K, Ikeuchi H, Kamikozuru K, Hida N, Ohda Y, Yokoyama Y, et al. Scheduled infliximab monotherapy to prevent recurrence of Crohn’s disease following ileocolic or ileal resection: a 3-year prospective randomized open trial. Inflamm Bowel Dis. 2012;18(9):1617–23.PubMedGoogle Scholar
  203. 203.
    Yamamoto T, Umegae S, Matsumoto K. Impact of infliximab therapy after early endoscopic recurrence following ileocolonic resection of Crohn’s disease: a prospective pilot study. Inflamm Bowel Dis. 2009;15(10):1460–6.PubMedGoogle Scholar

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2016

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (, which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Authors and Affiliations

  1. 1.Department of SurgeryVanderbilt University HospitalNashvilleUSA
  2. 2.Department of SurgeryGeorgia Regents UniversityAugustaUSA

Personalised recommendations