Crohn’s disease affects young people’s small bowel and should be managed conservatively and be operated for complications which do not respond to medical treatment. Crohn’s disease complications are sinuses, abscesses and stenoses. Operation should be limited to what is necessary, as any cm of the small bowel is essential as these patients may be operated more than once during lifetime.
The patient who suffers from ulcerative colitis will come to theatre for an operation which is usually, when not urgent, a total colectomy, excision of the rectum leaving a small stump and anastomosis of a sac made by folding the small bowel (ileal reservoir) to the rectal stump.
Surgery is necessary when conservative treatment fails, when a complication happens and when the disease is long standing, making the risk for colon cancer substantial. In this case, the increased number of bowel movements and continence, is less severe as we keep the last few cm of rectum intact.
Collaboration of gastroenterologists and surgeons is of great importance for the management of these patients.
The operation when needed should to be performed at the most appropriate time and when the patient is at the best possible condition.