Surgical treatment of inflammatory bowel disease

Although laparotomy with resection remains the treatment of choice for most patients who require surgery for intestinal Crohn's disease, mounting evid ence supports the safety and efficacy of less traditional approaches and pr ocedures (ie, laparoscopy, strictureplasty). In contrast to the approach to intestinal disease, many centers are advocating a more aggressive operativ e approach to perianal Crohn's disease. Over the past few years, restorativ e proctocolectomy with ileal pouch-anal anastomosis has emerged as the oper ation of choice for most patients requiring surgery for ulcerative colitis. As experience with the operation grows, patient selection, technical featu res, and management of postoperative complications are being more clearly d efined and optimized. (C) 1999 Lippincott Williams & Wilkins, Inc.