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Difficult Decisions in Colorectal Surgery pp 97–111Cite as

Post-operative Prophylaxis in Patients with Crohn’s Disease

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Crohn’s disease (CD) is a chronic relapsing inflammatory condition, characterized by abscesses, fistulization and stricturing that can affect any part of the gastrointestinal tract, but most commonly affects the terminal ileum and proximal colon. Up to 80 % of CD patients will require at least one abdominal surgery in their lifetime [1]. Unfortunately, surgery is not curative and recurrence is the norm, rather than the exception. Endoscopic recurrence occurs in upwards of 70–90 % of patients within 1 year of surgery [2, 3]. Clinical recurrence is seen in approximately one third of patients within 3 years of surgery [4]. Additionally, up to 50 % of patients will require a repeat surgery within 5 years, while up to 70 % will require a repeat operation within 20 years of their original procedure [4–7]. While prevention of post-operative recurrence is a significant challenge in clinical practice, it is essential for not only the maintenance of the patient’s health status and quality of life, but also for the prevention of disease relapse and future surgeries [8]. Having a multidisciplinary approach involving collaboration between surgeons and gastroenterologists is critical for optimizing post-operative care; however patients often delay their follow-up with their gastroenterologist, leaving the surgeon as the sole manager of the patient’s post-operative treatment. Communicating a well-organized and clear plan shortly after resection is especially important because patients who are at high risk of recurrence may be less likely to accept treatment as they enjoy their surgically-induced “remission [9].”

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Authors and Affiliations

  1. University of Chicago Medicine, Section of Hospital Medicine, 5841 S. Maryland Ave, MC 5000, Room 304, Chicago, IL, 60637, USA

    Jonathan Erlich

  2. University of Chicago Inflammatory Bowel Disease Center, 5841 S Maryland Ave, MC4076, Chicago, IL, 60302, USA

    David T. Rubin

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  1. Medical Center, University of Chicago, Chicago, Illinois, USA

    Neil Hyman

  2. Medical Center, University of Chicago, Chicago, Illinois, USA

    Konstantin Umanskiy

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Erlich, J., Rubin, D.T. (2017). Post-operative Prophylaxis in Patients with Crohn’s Disease. In: Hyman, N., Umanskiy, K. (eds) Difficult Decisions in Colorectal Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-40223-9_11

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