Segmental resection versus total proctocolectomy for Crohn's colitis: What is the best operation in the setting of medically refractory disease or dysplasia?

Amy Lightner

Research output: Contribution to journalReview article

1 Scopus citations


Crohn's disease (CD) may affect any part of the gastrointestinal tract. When isolated to the colon, and patients become medically refractory, there are several surgical options - segmental resection, subtotal colectomy with ileorectal anastomosis, or a total proctocolectomy and end ileostomy. Unfortunately, surgery does not cure CD, and, regardless of the extent of bowel removed, recurrence may be seen in the small bowel. This may lead to need for further immunosuppression or surgery. Therefore, when appropriate, a segmental colectomy or subtotal colectomy may prevent a permanent ostomy required with a total proctocolectomy. In the setting of dysplasia identified on colonoscopy, low quality evidence guides our treatment paradigms. Even though identification of dysplasia has greatly improved with chromoendoscopy, rates of synchronous or metachronous neoplasm remain high. Thus, a total proctocolectomy and end ileostomy, whereas a larger operation, may be best for the patient to remove all at risk tissue. Further research with prospective or randomized control trials is needed to improve our practice guidelines of both scenarios.

Original languageEnglish (US)
Pages (from-to)532-538
Number of pages7
JournalInflammatory Bowel Diseases
Issue number3
StatePublished - Feb 16 2018



  • Crohn's colitis
  • segmental resection
  • subtotal colectomy
  • total proctocolectomy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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