Surgical treatment of Crohn's disease

Chronic history of Crohn's disease (CD) with frequent relapses leads to major discomfort. Difficult medical control and occurrence of evolutive complications may require surgery. Most of the patients have to be operated on during CD. Surgical treatment is advised only when complications occur (stenosis, abces, or even no effect of medical treatment). Surgical resections have to be short, in order to preserve the longest intestinal segment. Their limits have to be situated in macroscopic normal tissues, with no need of long margins of macroscopically normal intestin. Anoperineal lesions are a difficult therapeutical challenge. Surgery is performed only when lesions are symptomatic and infected (fistulae, abcesses). Main problem in CD remains the high frequency of relapse. Numerous predictive factors have been observed. The only parameters which showed to be effective in preventing relapses are : the necessity to perfom the resection in an intestinal macrosopically normal zone, without lesion of CD, and the medical treatment of CD. Comfort evaluation in patients shows that the association of medical and surgical procedures leads to an acceptable functionnal status, even if no curative treatment exists at the moment.