The role of #surgery in inflammatory bowel disease with
@IBDBen
#MedTwitter #GITwitter #IBD #ACG2022
Good medical therapy has reduced need for surgery, but many still will require surgery
Over time, more surgery is elective (yay!)
Surgery is NOT a failure. It is a therapeutic option.
Non-modifiable risk factors for post-operative complications
💡Identify and monitor high-risk patients
⚠️Racial and socioeconomic disparities exist with respect to surgical outcomes
Modifiable risk factors
🍎nutrition
🩸anemia
🚬smoking
Pre-operative anti-TNF use
💉NOT associated with postoperative infections
Steroids are associated with postoperative complications
TNF management in elective surgery for Crohn disease
Stricturing disease has a high risk of requiring surgery
Endoscopic dilation 🆚 surgery
Intraabdominal abscess
Risk factors for colectomy in ulcerative colitis
Mortality benefit for surgery in patients >50
Make timely decisions- delaying surgery is associated with worse outcomes
"Our job is to save lives, not colons." -@IBDBen Call surgeon early in acute severe UC
Natural history of postoperative Crohn disease
Postoperative disease surveillance: 6 month colonoscopy 🥇
Risk stratify:
Pouch surveillance
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