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General Surgery
Perspective on Inflammatory Bowel Disease (B)
Built from Maingot's Abdominal Operations
What’s inside
5 sections · 69 slides
Overview
- What this topic covers
Ulcerative colitis and Crohn's disease
What the two diseases are, how common they are, and how often surgery is needed
- Inflammatory bowel disease defined
- 2–6%
- Endoscopic appearance of an inflamed colon
- Colonic mucosa in ulcerative colitis
- Reading the biopsy
- Granulomas in an intestinal lymph node
- Small and large intestine in the abdomen
- Change in surgical approach
- Abdominal wall after keyhole surgery
- Goals of medical therapy
- Role and timing of surgery
- Shared decision making with the patient
Cause, genetics and drug therapy
Why these diseases happen, and what infliximab did to the treatment of them
- Genetic predisposition in inflammatory bowel disease
- NOD2/CARD15 mutations in Crohn's disease
- Disease pattern linked to the NOD2/CARD15 mutation
- Infliximab and tumour necrosis factor alpha
- Randomised trial evidence for infliximab
- Established uses of infliximab in Crohn's disease
- Top-down therapy
- Concerns about infliximab around the time of surgery
- Conflicting data on postoperative complications
- Staging the pouch operation in refractory ulcerative colitis
- Cost and uptake of infliximab
- Single-institution studies of health care use
- Nationwide Inpatient Sample trends, 1998 to 2005
- Population data from Manitoba, Canada
- Reconciling small and large studies
- Interpretation of the utilisation evidence
Surgery for ulcerative colitis
Why the exact diagnosis matters, the ileoanal pouch, and the problems that follow it
- Importance of distinguishing the two diseases
- Choice of operation for colitis
- The ileoanal pouch operation
- Proctocolectomy with permanent ileostomy
- Quality of life after the two operations
- Pouchitis
- Symptoms and course of pouchitis
- Disease specificity of pouchitis
- Crohn's disease-like complications after ileal pouch-anal anastomosis
- Medical management of pouch complications
- Response of fistulising and stricturing pouch disease
- Histologic change in the pouch over time
- Sequence from pouch construction to cancer risk
- Reported cancers in the pouch and transition zone
- Guideline position on pouch surveillance
- Higher-risk groups who should be surveyed
- Uptake of laparoscopic ileoanal pouch surgery
- Laparoscopic versus open pouch: case-matched outcomes
- Case-matched comparison of pouch surgery
- Meta-analysis of laparoscopic pouch surgery
- Body image and quality of life after pouch surgery
- Adhesions, obstruction and fertility
Surgery for Crohn's disease
Operating on a disease that has no cure, recurs, and will need operating on again
- Principles of operating on Crohn's disease
- Why bowel length must be protected
- Resection margins in Crohn's disease
- Fat wrapping and the pinch test
- Checking the specimen and unexpected findings
- Small bowel adenocarcinoma in long-standing disease
- Dividing the mesentery in Crohn's disease
- Strictureplasty
- Selecting Crohn's patients for a laparoscopic approach
- Meta-analysis of ileocolic resection for Crohn's disease
- Indications for an open approach
- Summary: medical therapy
- Summary: surgical therapy
- References
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition