Inflammatory Bowel Disease: Update Course 2015

For Crohn's disease patients on TNF inhibitors, surgery should be delayed 2-4 weeks from the last infusion if possible

After surgery for Crohn's disease, TNF inhibitor therapy can be restarted at 2 weeks postoperatively if active disease is seen in other parts of the bowel, or at 4 weeks if disease is less aggressive

TNF inhibitors are associated with increased wound complications rather than anastomotic complications specifically

The decision to divert versus perform single-stage J-pouch is made intraoperatively based on ease of pouch descent, tissue health, and presence of tension

Timing of surgery in ulcerative colitis is determined by failure of medical therapy, which includes not just uncontrolled disease but also intolerable complications of medical management such as growth failure and long-term side effects of anti-TNF drugs and steroids

Surveillance colonoscopy is now an acceptable alternative to mandatory colectomy for ulcerative colitis patients, typically performed yearly

Only about 20% of patients with ulcerative colitis develop colon cancer by 20 years from the time of original diagnosis

For indeterminate colitis, conservative treatment options include diversion with ileostomy to observe the colon's response

For extensively diseased indeterminate colitis, subtotal colectomy with ileostomy provides a large specimen for pathologic determination of disease type

J-pouch procedures in indeterminate colitis carry more risk than in definitive ulcerative colitis

Creating a J-pouch in a patient who turns out to have Crohn's disease creates significantly more challenges than anticipated

Thin asthenic females with indeterminate colitis do not do well with J-pouch procedures

For indeterminate colitis, a stepwise approach (rather than immediate J-pouch) allows time to gather more diagnostic information

J-pouch procedures have a learning curve in terms of technical aspects

For pediatric J-pouch procedures, the rectum can be divided laparoscopically and averted or stapled at the columns, with the J-pouch created externally and anvil placed for EEA anastomosis, because adult staplers cannot fit into the pelvis in smaller children