Thread by @john_damianosMD

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

@IBDBen summary on surgery in #IBD