Place of Surgery in the Complex Treatment of Crohn’s Disease

INTRODUCTION: Conservative treatment of Crohn’s disease (CD) is focused on application of anti-inflammatory and immunosuppressive drugs. However, a large proportion of patients also need surgical treatment, the indications for which are often limited to such complications of the disease as the development of obstruction, perforation or abscess. Nevertheless, modern studies speak about the role of surgery in case of ineffectiveness of conservative treatment and the possibility of surgical intervention at an early stage. The article presents a literature review of PubMed, Medline, eLibrary databases for the last 10 years by keywords: Crohn’s disease, diagnostics, recurrence, surgical treatment, with the aim to summarize the current data on the interdisciplinary treatment of CD and determine the role of surgery in the complex process. CONCLUSION: Despite high effectiveness of biological therapy, treatment of CD and its complications remains a challenge, and the treatment interruption frequency due to the lack and loss of response remains relevant even with use of novel biological preparations. Besides, the primary endpoint of the studies should not be a recurrence-free period, but the quality of life and remission confirmed by clinical and endoscopic parameters. In terms of quality of life and cost-effectiveness, recent studies have shown the benefits of early surgery. Based on the existing data, all available treatment options (both medicinal and surgical) should be discussed with patients at an early stage of CD taking into account all risks and benefits, as well as patients’ personal preferences. Thus, it is necessary that all possible risk factors be taken into account to provide optimal and individual approach to treatment of a patient with CD, which can only be achieved by an interdisciplinary team of gastroenterologists, radiologists, morphologists and proctologists.