Manejo perioperatorio de la enfermedad inflamatoria intestinal

Abstract

Introduction

An important percentage of patients with inflammatory bowel disease will require surgical treatment at some point. Despite technological progress in the surgical and anaesthetic fields, figures for postoperative morbidity are still high. This alone requires a comprehensive review of perioperative protocols that will allow better surgical results.

Objective

To update all organisational and therapeutic measures that have proven to be effective when it comes to optimising the perioperative period.

Methods

Review of literature related to postoperative morbidity, immunosupression, radiology, nutrition, multidisciplinary teams and multimodal rehabilitation protocols.

Results

Management of inflammatory bowel disease, especially during the perioperative period, requires the coordinated action of a multidisciplinary team with a specific dedication to this condition. The surgical decision must be agreed upon clinical criteria and reinforced by means of modern imaging techniques. Sepsis, malnutrition and prolonged corticoid therapy have shown to be the principal determining factors for morbimortality after surgery. The presence of an abscess requires percutaneous drainage followed by surgery. Malnutrition states require aggressive nutritional therapy before the surgery and, whenever possible, the corticoid dosage should be reduced. Compliance with the current ERAS multimodal rehabilitation protocols can help shorten the admission period after surgery and offer an efficient and viable alternative for improving the postoperative period and the quality of life for patients.