Surgical Management Inflammatory Bowel Disease Ernesto R.
Drelichman, MD, FACS St. John Health Systems
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VARIETIES OF COLITIS
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ULCERATIVE COLITIS AND CROHNS DISEASE
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DISTINGUISHING FEATURES OF CROHNS DISEASE
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ANATOMIC DISTRIBUTION
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INFLAMMATION
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OBSTRUCTION
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ENDOSCOPIC APPEARANCES
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ENDOSCOPIC FEATURES
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COBBLESTONING
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Crohns Stricture
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FISTULIZATION
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Enterovesical Fistula
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PERIANAL FISTULAE AND ABSCESS
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GOALS OF THERAPY
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CONVENTIONAL DRUG THERAPIES
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OK, OK, you guys have had your chance the horses want another
shot at it.
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BALLOON DILATION OF CROHNS DISEASE STRICTURES
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Philosophy of Surgical Management There is no Cure for Crohns
Disease There is no Cure for Crohns Disease Surgery only overcomes
the complications Surgery only overcomes the complications
Potential for pan-intestinal involvement Potential for
pan-intestinal involvement
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Surgery: Risks and Benefits Symptom relief Improved nutrition
Reduced medication Surgical risk Disease recurrence Short bowel
syndrome
SURGICAL OPTIONS FOR INTRA- ABDOMINAL DISEASE IN CROHNS
DISEASE
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Inflammatory Bowel Disease Disease Related Challenges
Inflammatory Bowel Disease Disease Related Challenges
Immunosuppression Immunosuppression Malnutrition Malnutrition
fistulas fistulas abscess abscess phlegmon phlegmon thickened,
shortened mesentery thickened, shortened mesentery friable tissues
and vessels friable tissues and vessels Extensive disease Extensive
disease
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Step 5: Exteriorization, Resection, and Anastomosis
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Step 4: Externalization
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Step 5: Resection and Anastomosis
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Crohns Disease Laparoscopic Colectomy - Advantages *33 patients
with ileocolic Crohns underwent laparoscopic ileocectomy were case
matched for potential confounders to an open group *33 patients
with ileocolic Crohns underwent laparoscopic ileocectomy were case
matched for potential confounders to an open group * > 60% had
undergone previous surgery Young-Fadok et al. Surg Endosc
2001;450-4: Young-Fadok et al. Surg Endosc 2001;450-4: