Surgical techniques in inflammatory bowel disease

Although medical treatment for inflammatory bowel disease has become more effective, surgical interventions in patients particularly suffering from Crohn's disease are frequent. As surgery for Crohn's disease does not include definitive curation from the disease, restorative proctocolectomy with ileal-pouch-anal anastomisis is performed with curative intent. Most frequent indications for surgery in Crohn's disease include small bowel obstruction and fistulas. Main indications for surgery in ulcerative colitis are high-grade neoplasia (IEN) and colitis-associated carcinoma. Surgical strategy and technique are mainly determined by the type of disease, whereas the type of anastomosis (end-to-end vs. side-to-side), the role of stricturoplasty as well as innovative strategies for perianal fistula in Crohn's disease, and the role of anastomosis in ulcerative colitis are under controversial discussion. Specifically focussing on minimally invasive surgery, potential benefits of laparoscopic surgery in patients with inflammatory bowel disease include reduction of surgical trauma, fast recovery and improved cosmetic when compared to conventional approach. Most common laparoscopic procedures for Crohn's disease include ileocecal resection and stoma creation for fecal diversion, and laparoscopic-assisted proctocolectomy for ulcerative colitis. Data of comparative studies have shown that laparoscopic resection is not associated with increased morbidity rates. In general, the indication for surgery has not changed with the application of laparoscopy.