Surgical strategies in multidisciplinary management of Crohn's disease

Despite significant advances in medical therapy, particularly biological agents, a significant number of patients still need surgery as an important therapeutic tool in Crohn's disease (CD). The role of a surgeon in the multidisciplinary team in inflammatory bowel disease care is essential. Discussion with gastroenterologists, radiologists and dietitians to proper define the best timing of surgery after optimization and the best surgical strategy that will be used impact in better postoperative outcomes in CD patients. In this review the authors discuss important aspects involved in the surgical strategies of the multidisciplinary management of CD, including preoperative planning and optimization, the definition of the more adequate approach and technique according to the disease location, and adequate prevention of postoperative recurrence. Several aspects including patients' past and present features are important in making the right decision in the surgical management of CD. Adequate preparation of the nutritional status, correction of anemia, optimization of medical therapy and anatomic mapping of the small bowel and colon with imaging tests are essential for the definition of best timing and type of surgery in abdominal resections in CD patients. This fact demonstrates the specific need fora multidisciplinary team in the management of CD surgical patients.