TY  - JOUR
A1  - Kelm, Matthias
A1  - Germer, Christoph-Thomas
A1  - Schlegel, Nicolas
A1  - Flemming, Sven
T1  - The revival of surgery in Crohn's disease — early intestinal resection as a reasonable alternative in localized ileitis
JF  - Biomedicines
N2  - Crohn's disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD.
KW  - surgery
KW  - Crohn's disease
KW  - terminal ileitis
KW  - inflammatory bowel disease
KW  - surgical outcome
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246296
SN  - 2227-9059
VL  - 9
IS  - 10
ER  - 
TY  - JOUR
A1  - Kelm, Matthias
A1  - Anger, Friedrich
A1  - Eichlinger, Robin
A1  - Brand, Markus
A1  - Kim, Mia
A1  - Reibetanz, Joachim
A1  - Krajinovic, Katica
A1  - Germer, Christoph-Thomas
A1  - Schlegel, Nicolas
A1  - Flemming, Sven
T1  - Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease
JF  - Journal of Clinical Medicine
N2  - Despite the increasing incidence and prevalence of Crohn’s Disease (CD), no curative options exist and treatment remains complex. While therapy has mainly focused on medical approaches in the past, growing evidence reveals that in cases of limited inflammation, surgery can suffice as an alternative primary treatment. We retrospectively assessed the disease course and outcomes of 103 patients with terminal Ileitis who underwent primary surgery (n = 29) or received primary medical treatment followed by surgery (n = 74). Primary endpoint was the need for immunosuppressive medication after surgical treatment (ileocecal resection, ICR) during a two-years follow-up. Rates for laparoscopic ICR were enhanced in case of early surgery, but no differences were seen for postoperative complications. In case of immunosuppressive medication, patients with ICR at an early state of disease needed significantly less anti-inflammatory medication during the two-year postoperative follow-up compared to patients who were primarily treated medically. Furthermore, in a subgroup analysis for patients with localized ileocecal disease manifestation, early surgery consistently resulted in a decreased amount of medical therapy postoperatively. In conclusion primary ICR is safe and effective in patients with limited CD, and the need for immunosuppressive medication during the postoperative follow-up is low compared to patients receiving surgery at a later stage of disease.
KW  - Crohn’s Disease
KW  - surgical therapy
KW  - ileocecal resection
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228822
SN  - 2077-0383
VL  - 10
IS  - 4
ER  -