Abordagem cirúrgica da Doença de Crohn
DOI:
https://doi.org/10.34117/bjdv9n4-075Keywords:
abordagem cirúrgica, doença gastrointestinal, Doença de CrohnAbstract
A terapia médica é a base do tratamento para a maioria dos pacientes com doença de Crohn. O manejo operatório é reservado para aqueles que desenvolvem complicações. Pacientes com abscesso intra-abdominal devem ser tratados com antibióticos e submetidos à drenagem percutânea ou cirúrgica do abscesso, seguida de ressecção cirúrgica do segmento intestinal envolvido após a resolução da sepse. A drenagem percutânea é preferível à drenagem cirúrgica sempre que possível. As indicações para ressecção possuem as suas particularidade que devem ser avaliada em cada caso.
References
Lightner AL, Vogel JD, Carmichael JC, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn's Disease. Dis Colon Rectum 2020; 63:1028.
Aberra FN, Lewis JD, Hass D, et al. Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 2003; 125:320.
Subramanian V, Pollok RC, Kang JY, Kumar D. Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg 2006; 93:793.
Marchal L, D'Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn's disease: a controlled cohort study. Aliment Pharmacol Ther 2004; 19:749.
Gaertner WB, Decanini A, Mellgren A, et al. Does infliximab infusion impact results of operative treatment for Crohn's perianal fistulas? Dis Colon Rectum 2007; 50:1754.
Lightner AL, McKenna NP, Tse CS, et al. Postoperative outcomes in vedolizumab-treated Crohn's disease patients undergoing major abdominal operations. Aliment Pharmacol Ther 2018; 47:573.
Lightner AL, McKenna NP, Tse CS, et al. Postoperative Outcomes in Ustekinumab-Treated Patients Undergoing Abdominal Operations for Crohn's Disease. J Crohns Colitis 2018; 12:402.
Ahmed Ali U, Martin ST, Rao AD, Kiran RP. Impact of preoperative immunosuppressive agents on postoperative outcomes in Crohn's disease. Dis Colon Rectum 2014; 57:663.
Papaconstantinou I, Zeglinas C, Gazouli M, et al. The impact of peri-operative anti-TNF treatment on anastomosis-related complications in Crohn's disease patients. A critical review. J Gastrointest Surg 2014; 18:1216.
White EC, Melmed GY, Vasiliauskas E, et al. Does preoperative immunosuppression influence unplanned hospital readmission after surgery in patients with Crohn's disease? Dis Colon Rectum 2012; 55:563.
Pozza A, Scarpa M, Lacognata C, et al. Magnetic resonance enterography for Crohn's disease: what the surgeon can take home. J Gastrointest Surg 2011; 15:1689.
Siddiki HA, Fidler JL, Fletcher JG, et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease. AJR Am J Roentgenol 2009; 193:113.
