Early Surgery for Patients With Ileal Crohn's Disease.

D i s e a s e Early Surgery for Patients With Ileal Crohn's Disease G&H Could you explain the concept of early surgery in ileal Crohn's disease?GD Surgery has traditionally been used for the treatment of medically intractable disease or complications.In Crohn's disease, complications typically involve a perforation with an abscess or a stenosis that cannot be endoscopically managed and is symptomatic, where the patient has cramps after eating, and medically intractable disease refers to symptoms continuing despite use of the medical treatments currently available.Almost half of patients with Crohn's disease have some type of surgery in which the diseased part of the bowel is resected at some time in their disease course.Essentially, traditional surgery can be considered late surgery, as it is performed when all other options have been tried but none work.Early surgery refers to the performance of resection in the first years after diagnosis without the presence of complications.There is no stenosis or perforation, nor is there an abscess.The disease is limited and typically located in the last part of the small bowel or terminal ileum.When the length of the diseased bowel is not too long, the idea is to resect it so that the patient is free from disease.This is called surgical remission.Essentially, the patient can start over with no Crohn's disease visible and is then followed intensively.As soon as disease recurs, it can be treated with medication.Early disease is much more responsive to medication than advanced or established disease.