Contemporary aspects of surgery in patients with complicated forms of Crohn's disease—indications and contraindications—a personalized approach to surgical treatment
DOI:
https://doi.org/10.14748/aksns311Keywords:
Crohn's diseaseAbstract
Introduction: Crohn's disease (CD) is part of a special group of non-specific inflammatory bowel diseases, which has been increasing in Bulgaria and worldwide over the last decade. Although drug therapy plays a major role in the treatment of these diseases, about 80% of patients with CD require surgical treatment at least once in their lifetime.
Aim: The aim of this article is to analyze institutional experience in the treatment of complicated forms of inflammatory bowel diseases (IBDs), to evaluate the choice of surgical treatment tactics, to assess different surgical options, to research an individualized approach, and to refine the risks of surgical treatment.
Materials and Methods: Retrospective, single-center study for the period from January 1, 2012, to June 30, 2025, based on diagnostic and anamnestic data, imaging and endoscopic examinations, surgical protocols, decisions of in-hospital medical councils, and results of postoperative follow-up in the hospital system has been conducted.
Results: The study covered a total of 30 patients with complicated forms of CD. The average age was 47 years, with a male/female ratio of 1:1.7 (n = 11/19). Over 70% of surgical interventions were performed as an emergency. The most common surgical intervention was right hemicolectomy with manual anastomosis. One case was specified as contraindicated for surgical treatment due to involvement of the main mesenteric vascular structures in the active process. In one case, surgical treatment was performed in two surgical stages to reduce the risk of subsequent insufficiency. In one case, the disease was accidental finding. In two cases, CD of the colon was diagnosed. In two cases, there was progression of the disease with abscess formation in the anterior abdominal wall.
Discussion: Crohn’s disease is characterized by recurrent complications, in which surgical methods are indicated only to overcome the acute complications of the underlying process, but sometimes even the possibilities for surgical treatment of the disease prove to be unsuccessful and ineffective.
Conclusion: The study demonstrated that the surgical strategy for patients with complicated CD needs to be thoroughly discussed by a multidisciplinary team in order to assess the surgical options for patients. Surgery is the method of choice and the only possible solution in severe forms of CD when the possibilities for medical treatment have been exhausted.
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