Optimal Timing for Surgery

Within the article titled, "Optimal Timing of Surgery for Inflammatory Bowel Disease," it discusses how necessary surgery is when compared to having ulcerative colitis and Crohn's disease. Only 20% of people diagnosed with ulcerative colitis are required to have surgery at one point of their illness, while 80% of the patients with Crohn's disease are obliged to have surgery. For patients with ulcerative colitis, after surgery they are permanently cured. The surgery many surgeons suggest their patients get is total proctocolectomy because other surgeries such as partial proctocolectomy, ileoanal pouch anastomosis, and permanent stoma will not permanently cure them from UC. Thus, many surgeons it is better to perform surgery at an early stage of UC. As of today, there is no surgery that can sure Crohn's disease, but it can be to treat symptoms when the patient is not responding to medical treatment. Even then, about 20% of the patients have reoccurring symptoms after 2 years and 80% of them will show signs of symptoms again after 20 years. The surgeons have seen that if the surgery is for lessening the effects of fibrostenotic disease and not perforating or fistulizing disease there will be less frequency in how many times the symptoms reoccur. Overall, deciding when to have surgery must be a thoroughly thought-out decision for both the surgeon and the patient. Most of the time, by delaying the time of surgery can tremendously increase the suffering and pain the patient experiences and reduce the chances of having a good outcome. In contrast, while delaying other medications could continue to improve the situation and eventually eliminate the need for surgery. In addition, if during the delay time the symptoms such as infections could be reduced and as a result lessening the risk of morbidity.
In a study done in England, it showed that the rate of mortality for patients who received surgery compared to ones who had not elected for surgery in either ulcerative colitis or Crohn's disease patients lived longer. Three years after surgery only 3.7% of patients with UC died after having surgery while the mortality for patients without surgery was 13.6%. Same with Crohn's disease patients, it increased significantly from patients that had surgery to patients who had not, 3.3% and 10.1% respectively. On the other hand, patients who had a emergency colectomy versus patients who elected themselves for the surgery had higher mortality rates. The study was done in the Oxford region with 23,464 patients from 1968 until 1996.

Sources:

"Threshold for Elective Colectomy Called Too High." Medical News.


Hodin R.S. "Optimal Timing of Surgery for Inflammatory Bowel Disease." SpringerLink.