RECURRENT CROHNS-DISEASE - SURGICAL THERA PY

The surgical therapy of recurrent Crohn's disease requires due to a re currence rate of 60 % after 15 years special precautions. The major pr inciple of therapy is a minimal resecting surgery. This concerns mainl y strictures and stenosis. Strictures should be treated by stricturopl asty and stenosis by limited resection. Recurrent fistulas should be t rated conservatively. Just in case of interenteric and enterocutaneous fistula with a concomittant short bowel syndrome, in blind ending fis tulas with an abscess or in enterovesical fistulas we recommend immedi ate operation. The therapy of recurrent anorectal Crohn's disease unde rlies the same rules as the primary therapy. If necessary, proctectomy remains an important option. Also emergency surgery in recurrent Croh n's disease follows the same rules as in elective surgery.