Surgical Options in Small-Bowel Disease

Treatment of chronic intestinal inflammatory diseases, CD in particular, requires from disease onset a multidisciplinary approach involving pathologist, gastroenterologist, nutritionist, radiologist, surgeon and psychologist. Availability of increasingly efficient medical therapies has made it possible to take a pharmacological approach giving good results. However, due to this approach, surgeons tend to see more patients who are considerably weakened from a general and psychological point of view. Extensive use of mini-invasive techniques (laparoscopic approach, stricturoplasties or minor resections), have reduced mortality and morbility associated with surgical procedures. Even recognising the high rate of disease relapses after surgery, the appropriate surgical timing may allow the patient a better life style and a more appropriate use of the pharmacologic therapy with a better response. If treatment of complications falls clearly into the surgeon’s area of competence, this therapeutic option can be used not only in “extreme” conditions but, more appropriately, in the case of poor response to medical therapy. Close cooperation among the various professional figures is increasingly important in order to assess the various therapeutical options and offer each patient tailored therapy and a high degree of professionalism, which may be assured only by referenced centres with a high number of cases treated.