SURGICAL STRATEGY IN PATIENTS WITH M-CROH N OF TERMINAL ILEUM AND COLON

Most patients with Crohn's disease have to be operated on. Necessity t o loose some amount of the intestine and time-point of the surgical in tervention may be derived from the irreversible cascade of the inflamm atory process and the limitations of the conservative treatment. In il eocecal disease indications for surgery are represented by stenotic an d/or penetrating complications of the inflamed bowel, whereas in Crohn 's colitis acute or terminal medical refractority is predominating. St andard-procedures result from constantly definable patterns of the dis ease manifestation: ileocecal resection and colectomy/-proctocolectomy . In segmental colitis sometimes ''resections within Crohn's'' may be adequate in a first attempt to avoid anticipating the natural course b y surgical means. In these cases the further prognosis depends on the treatment possibilities of the remaining colon. In contrast, true recu rrence is a new inflammation of the neoterminal ileum and may indicate repeated reresections. The frequence decreases with the number of res ections. Nevertheless nutritional status is restored even by multiple resections, whereas specific functional sequelae of the resection - di stal resection- and dehydration syndromes - are well treatable mostly. In the case of appropriate timing of the operation and the reoperatio n operative morbidity and mortality are remarkable low today resulting in an almost normal life expectancy. Most important as negative progn ostic factor remains sepsis resulting from pre-existing or postoperati ve infectious complications. Keeping this in mind experimental pharmac o-therapy to delay the operation and not profoundly substantiated tend encies to minimize surgery are to be considered only with critical sce pticism. At the moment, future research is thought to be more successf ul in focussing prophylaxis of ileal recurrence than avoiding surgery.