Clin Colon Rectal Surg 2013; 26(02): 075-079
DOI: 10.1055/s-0033-1348044
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preoperative Optimization of Crohn Disease

Amit Sharma
1   Division of Colon and Rectal Surgery, University of Medicine and Dentistry, Robert Wood Johnson Medical School, Edison, New Jersey
,
Bertram T. Chinn
1   Division of Colon and Rectal Surgery, University of Medicine and Dentistry, Robert Wood Johnson Medical School, Edison, New Jersey
› Author Affiliations
Further Information

Publication History

Publication Date:
27 June 2013 (online)

Abstract

Crohn disease is a chronic disease that is treated with aminosalicylates, antibiotics, and immunosuppressant agents. Most patients ultimately require surgical intervention and many will require additional surgery for recurrent disease. Consequently, surgery is generally performed only when medical management fails; however, these patients are often malnourished and immunosuppressed. Preoperative optimization is necessary to minimize morbidity, including intra-abdominal septic complications and anastomotic leaks. In this article, the authors review some considerations to improve the surgical outcome in Crohn disease.

 
  • References

  • 1 Loftus Jr EV, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn's disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther 2002; 16 (1) 51-60
  • 2 Wagner IJ, Rombeau JL. Nutritional support of surgical patients with inflammatory bowel disease. Surg Clin North Am 2011; 91 (4) 787-803 , viii
  • 3 Tay GS, Binion DG, Eastwood D, Otterson MF. Multivariate analysis suggests improved perioperative outcome in Crohn's disease patients receiving immunomodulator therapy after segmental resection and/or strictureplasty. Surgery 2003; 134 (4) 565-572 , discussion 572–573
  • 4 Smedh K, Andersson M, Johansson H, Hagberg T. Preoperative management is more important than choice of sutured or stapled anastomosis in Crohn's disease. Eur J Surg 2002; 168 (3) 154-157
  • 5 Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P. Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn's disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 2007; 50 (3) 331-336
  • 6 Yamamoto T, Allan RN, Keighley MRB. Risk factors for intra-abdominal sepsis after surgery in Crohn's disease. Dis Colon Rectum 2000; 43 (8) 1141-1145
  • 7 White JV, Guenter P, Jensen G, Malone A, Schofield M. Academy Malnutrition Work Group, A.S.P.E.N. Malnutrition Task Force, A.S.P.E.N. Board of Directors. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr 2012; 36 (3) 275-283
  • 8 Meijers JM, van Bokhorst-de van der Schueren MA, Schols JM, Soeters PB, Halfens RJ. Defining malnutrition: mission or mission impossible?. Nutrition 2010; 26 (4) 432-440
  • 9 Razack R, Seidner DL. Nutrition in inflammatory bowel disease. Curr Opin Gastroenterol 2007; 23 (4) 400-405
  • 10 Passos RA, Santana GO, Andrade A , et al. Response to cachexia in Crohn's disease following treatment with anti-TNF; a case report. Rev Bras Nutr Clin 2006; 21: 333-336
  • 11 Badia-Tahull MB, Llop-Talaveron J, Fort-Casamartina E , et al. Preoperative albumin as a predictor of outcome in gastrointestinal surgery. e-SPEN, Eur e-J Clin Nutr Metab 2009; 4 (5) e248-e251
  • 12 Saha AK, Tapping CR, Foley GT , et al. Morbidity and mortality after closure of loop ileostomy. Colorectal Dis 2009; 11 (8) 866-871
  • 13 Mäkelä JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003; 46 (5) 653-660
  • 14 Suding P, Jensen E, Abramson MA, Itani K, Wilson SE. Definitive risk factors for anastomotic leaks in elective open colorectal resection. Arch Surg 2008; 143 (9) 907-911 , discussion 911–912
  • 15 Telem DA, Chin EH, Nguyen SQ, Divino CM. Risk factors for anastomotic leak following colorectal surgery: a case-control study. Arch Surg 2010; 145 (4) 371-376 , discussion 376
  • 16 Jacobson S. Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition. Scand J Gastroenterol 2012; 47 (2) 170-177
  • 17 Allardyce DB. Preoperative parenteral feeding in Crohn's disease: preoperatively, to induce remission, and at home. Am Surg 1978; 44 (8) 510-516
  • 18 Lashner BA, Evans AA, Hanauer SB. Preoperative total parenteral nutrition for bowel resection in Crohn's disease. Dig Dis Sci 1989; 34 (5) 741-746
  • 19 Hartman C, Eliakim R, Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol 2009; 15 (21) 2570-2578
  • 20 O'Moráin C, Segal AW, Levi AJ. Elemental diet as primary treatment of acute Crohn's disease: a controlled trial. Br Med J (Clin Res Ed) 1984; 288 (6434) 1859-1862
  • 21 Saverymuttu S, Hodgson HJ, Chadwick VS. Controlled trial comparing prednisolone with an elemental diet plus non-absorbable antibiotics in active Crohn's disease. Gut 1985; 26 (10) 994-998
  • 22 Okada M, Yao T, Yamamoto T , et al. Controlled trial comparing an elemental diet with prednisolone in the treatment of active Crohn's disease. Hepatogastroenterology 1990; 37 (1) 72-80
  • 23 Zoli G, Carè M, Parazza M , et al. A randomized controlled study comparing elemental diet and steroid treatment in Crohn's disease. Aliment Pharmacol Ther 1997; 11 (4) 735-740
  • 24 Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K. Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn's disease: a prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther 2007; 25 (1) 67-72
  • 25 Lee G, Buchman AL. DNA-driven nutritional therapy of inflammatory bowel disease. Nutrition 2009; 25 (9) 885-891
  • 26 Han PD, Burke A, Baldassano RN, Rombeau JL, Lichtenstein GR. Nutrition and inflammatory bowel disease. Gastroenterol Clin North Am 1999; 28 (2) 423-443 , ix
  • 27 Trebble TM, Arden NK, Wootton SA , et al. Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn disease. Am J Clin Nutr 2004; 80 (5) 1137-1144
  • 28 Post S, Betzler M, von Ditfurth B, Schürmann G, Küppers P, Herfarth C. Risks of intestinal anastomoses in Crohn's disease. Ann Surg 1991; 213 (1) 37-42
  • 29 Xie Y, Zhu W, Li N, Li J. The outcome of initial percutaneous drainage versus surgical drainage for intra-abdominal abscesses in Crohn's disease. Int J Colorectal Dis 2012; 27 (2) 199-206
  • 30 Rypens F, Dubois J, Garel L, Deslandres C, Saint-Vil D. Percutaneous drainage of abdominal abscesses in pediatric Crohn's disease. AJR Am J Roentgenol 2007; 188 (2) 579-585
  • 31 Gutierrez A, Lee H, Sands BE. Outcome of surgical versus percutaneous drainage of abdominal and pelvic abscesses in Crohn's disease. Am J Gastroenterol 2006; 101 (10) 2283-2289
  • 32 Lee H, Kim YH, Kim JH , et al. Nonsurgical treatment of abdominal or pelvic abscess in consecutive patients with Crohn's disease. Dig Liver Dis 2006; 38 (9) 659-664
  • 33 Thoreson R, Cullen JJ. Pathophysiology of inflammatory bowel disease: an overview. Surg Clin North Am 2007; 87 (3) 575-585
  • 34 Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR. Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 2003; 125 (2) 320-327
  • 35 Zerbib P, Koriche D, Truant S , et al. Pre-operative management is associated with low rate of post-operative morbidity in penetrating Crohn's disease. Aliment Pharmacol Ther 2010; 32 (3) 459-465
  • 36 Subramanian V, Saxena S, Kang JY, Pollok RC. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol 2008; 103 (9) 2373-2381
  • 37 Tzivanakis A, Singh JC, Guy RJ, Travis SP, Mortensen NJ, George BD. Influence of risk factors on the safety of ileocolic anastomosis in Crohn's disease surgery. Dis Colon Rectum 2012; 55 (5) 558-562
  • 38 Bruewer M, Utech M, Rijcken EJ , et al. Preoperative steroid administration: effect on morbidity among patients undergoing intestinal bowel resection for Crohńs disease. World J Surg 2003; 27 (12) 1306-1310
  • 39 Canedo J, Lee SH, Pinto R, Murad-Regadas S, Rosen L, Wexner SD. Surgical resection in Crohn's disease: is immunosuppressive medication associated with higher postoperative infection rates?. Colorectal Dis 2011; 13 (11) 1294-1298
  • 40 Mascarenhas C, Nunoo R, Asgeirsson T , et al. Outcomes of ileocolic resection and right hemicolectomies for Crohn's patients in comparison with non-Crohn's patients and the impact of perioperative immunosuppressive therapy with biologics and steroids on inpatient complications. Am J Surg 2012; 203 (3) 375-378 , discussion 378
  • 41 Schlaghecke R, Kornely E, Santen RT, Ridderskamp P. The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N Engl J Med 1992; 326 (4) 226-230
  • 42 Ackerman GL, Nolsn CM. Adrenocortical responsiveness after alternate-day corticosteroid therapy. N Engl J Med 1968; 278 (8) 405-409
  • 43 Fauci AS. Alternate-day corticosteroid therapy. Am J Med 1978; 64 (5) 729-731
  • 44 LaRochelle Jr GE, LaRochelle AG, Ratner RE, Borenstein DG. Recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients with rheumatic diseases receiving low-dose prednisone. Am J Med 1993; 95 (3) 258-264
  • 45 Stewart PM. The adrenal cortex. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, , eds. Williams Textbook of Endocrinology. 10th ed. Philadelphia, PA: Saunders; 2003: 491-551
  • 46 Livanou T, Ferriman D, James VH. Recovery of hypothalamo-pituitary-adrenal function after corticosteroid therapy. Lancet 1967; 2 (7521) 856-859
  • 47 Krasner AS. Glucocorticoid-induced adrenal insufficiency. JAMA 1999; 282 (7) 671-676
  • 48 Myrelid P, Olaison G, Sjödahl R, Nyström PO, Almer S, Andersson P. Thiopurine therapy is associated with postoperative intra-abdominal septic complications in abdominal surgery for Crohn's disease. Dis Colon Rectum 2009; 52 (8) 1387-1394
  • 49 Colombel JF, Loftus Jr EV, Tremaine WJ , et al. Early postoperative complications are not increased in patients with Crohn's disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 2004; 99 (5) 878-883
  • 50 Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 2007; 369 (9573) 1641-1657
  • 51 Hanauer SB, Feagan BG, Lichtenstein GR , et al; ACCENT I Study Group. Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet 2002; 359 (9317) 1541-1549
  • 52 Appau KA, Fazio VW, Shen B , et al. Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn's patients. J Gastrointest Surg 2008; 12 (10) 1738-1744
  • 53 Marchal L, D'Haens G, Van Assche G , et al. The risk of post-operative complications associated with infliximab therapy for Crohn's disease: a controlled cohort study. Aliment Pharmacol Ther 2004; 19 (7) 749-754
  • 54 Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L. Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg 2008; 12 (10) 1730-1736 , discussion 1736–1737
  • 55 White EC, Melmed GY, Vasiliauskas E , et al. Does preoperative immunosuppression influence unplanned hospital readmission after surgery in patients with Crohn's disease?. Dis Colon Rectum 2012; 55 (5) 563-568
  • 56 Mahid SS, Minor KS, Soto RE, Hornung CA, Galandiuk S. Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc 2006; 81 (11) 1462-1471
  • 57 Lindberg E, Järnerot G, Huitfeldt B. Smoking in Crohn's disease: effect on localisation and clinical course. Gut 1992; 33 (6) 779-782
  • 58 Galeazzi F, Blennerhassett PA, Qiu B, O'Byrne PM, Collins SM. Cigarette smoke aggravates experimental colitis in rats. Gastroenterology 1999; 117 (4) 877-883
  • 59 Yamamoto T, Keighley MR. Smoking and disease recurrence after operation for Crohn's disease. Br J Surg 2000; 87 (4) 398-404
  • 60 Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive Summary. Chest 2012; 141 (2, Suppl): 7S-47S
  • 61 Kappelman MD, Horvath-Puho E, Sandler RS , et al. Thromboembolic risk among Danish children and adults with inflammatory bowel diseases: a population-based nationwide study. Gut 2011; 60 (7) 937-943
  • 62 Bernstein CN, Blanchard JF, Houston DS, Wajda A. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost 2001; 85 (3) 430-434
  • 63 Scarpa M, Pilon F, Pengo V , et al. Deep venous thrombosis after surgery for inflammatory bowel disease: is standard dose low molecular weight heparin prophylaxis enough?. World J Surg 2010; 34 (7) 1629-1636