Surgery should be recommended for UC that does not respond to intensive drug therapy. The decision to operate is best made by the gastroenterologist and colorectal surgeon in conjunction with the patient. Other conditions such as heterogeneous hyperplasia or carcinoma, poorly controlled disease, acute exacerbation of chronic UC, or acute exacerbation of residual colonic UC after colectomy should be discussed in terms of the choice of surgical treatment.
Patients with CD should be operated on only in symptomatic rather than asymptomatic patients, and preoperative imaging should be performed because of the potential for penetration, which usually recurs after surgery. Bowel segment resection must be conservative. There are few randomized controlled clinical trials on the choice of surgery and surgical procedures for IBD.
The general principles are as follows: 1. Patients with IBD requiring surgery should preferably be treated under the joint care of a surgeon and gastroenterologist with an interest in IBDD (Level C).
Preoperative consultation and marking of the fistula site must be performed by a clinical colorectal care specialist with expertise in fistula treatment (Level C).
An intermediate incision is usually used for dissection in patients with IBD (level B).
4. For acute fulminant UC or CD, a subtotal colectomy is chosen, preserving a long segment of the rectum, integrating it into the lower end of the laparotomy or removing it to make a mucus fistula to facilitate future rectal resection and to minimize the risk of intra-abdominal fissure (level B).