The treatment of Crohn’s disease, one of the two chronic intestinal inflammatory diseases together with ulcerative colitis, provides several therapeutic options: drug therapies and, when necessary, surgical therapies. But in which cases should surgery be used? We talk about this topic with Professor Antonino Spinelli, head of the Colorectal Surgery Unit at the Humanitas Clinical Institute and professor at Humanitas University.
The goal of Crohn’s disease treatment is the effective symptom control and prevention of complications, alleviating the impact of the disease and improving the quality of patients’ life. Approximately 70% of patients with Crohn’s disease resort to surgery in their lifetime, when drug therapies are no longer able to control the symptoms or there is evidence of complications, which can only be resolved by surgery. Fistulas, abscesses (especially perianal) and intestinal stenosis are the main complications of the disease and the ones that most frequently require surgical treatment. The type of treatment depends on the degree and severity of the injuries.
Surgery in general has the great potential to rapidly improve the quality of life of patients in whom pharmacological attempts have not been effective, but it is not conclusive, since Crohn’s disease is a chronic condition which could require a new intervention. For this reason, specialized surgical techniques have been developed to save the gut and lessen the abdominal wall (laparoscopy and minimally invasive surgery in general) as much as possible.
Despite the remarkable progress of modern surgery, three years after the operation in about 80% of endoscopically treated patient there is disease reappearance and some of these patients may need new interventions in the future. The development of pharmacological therapies and, in particular, the introduction of biological drugs, can contribute to lower recurrence and with it the need for further surgical interventions.
For this reason we believe the synergy between surgeon and gastroenterologist is important, so that the subsequent continuation of drug therapy can be combined with surgical therapy, reducing and delaying the onset of recurrences.