Journal Review in Colorectal Surgery: Timing of Biologics and Surgery in the Setting of Crohn’s Disease

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 21 July 2022

⏱️ 31 minutes

🔗️ Recording | iTunes | RSS

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Summary

You get consulted on a 34-year-old with ileocolic Crohn’s disease on Humira. You determine he needs surgery for recurrent partial obstructions. When do you do the surgery? How long should he be off his biologic medication? When to restart it post op? Join Drs. Abelson, Marcello and Aulet as they take us through two articles to help us figure it out!

Learning Objectives:
1. Describe the complications of biologic medications in the peri-operative period
2. List the different classifications of medications for Crohn’s disease
3. Discuss the approach to managing timing of surgery for patients with crohn’s disease

Articles:
Cohen BL, Fleshner P, Kane SV et al. Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery. Gastroenterology. 2022 Apr 10;S0016-5085(22)00359-6. doi: 10.1053/j.gastro.2022.03.057. Online ahead of print.

Brouquet A, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y; GETAID chirurgie group. Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease: Results of a Prospective Nationwide Cohort. Ann Surg. 2018 Feb;267(2):221-228. doi: 10.1097/SLA.0000000000002017. PMID: 29300710.

Steele S, et al. The ASCRS Textbook of Colon and Rectal Surgery, fourth ed. 2022. https://link.springer.com/book/10.1007/978-3-030-66049-9

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Transcript

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0:00.0	Behind the Night, the surgery podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Hello, once again, to our Behind the Night listeners.
0:25.0	So we're excited to be back with you. This is our fourth episode coming from the Leahy colorectal team.
0:30.0	So this episode we're going to be grappling with the challenge of how to manage biologics for surgical resection and patients with Crohn's disease.
0:38.0	So we're going to review two journal articles that are going to help answer this question.
0:42.0	So I'm honored to be joined once again by Dr. Peter West Marcello and Dr. Tess Hannah Allett and then we do have a special guest later in the episode.
0:52.0	Gang, I feel like we've had some good quality time together.
0:55.0	Yeah, life's been good. Hey, team. Yeah, indeed, we saw each other in everybody else in our friends at the national meeting and our regional colorectal meeting.
1:04.0	We are down in Tampa for ASCRS and then a new part were down for our New England society of color to certain meetings.
1:11.0	Tess, how did you like the meeting?
1:13.0	It was great. I was so happy to be able to see everybody in person. Really wonderful time.
1:19.0	Nice. So before we get into our topic, I do want to give a shout out to the other colorectal surgery team in Montreal across the border, who are also contributing some awesome cases to behind the knife.
1:30.0	And so I recently listened to their clinical challenges in colorectal surgery, discussion Lynch syndrome. And so that episode aired on May 5th.
1:39.0	It's episode number 488. And so I definitely recommend checking that out.
1:44.0	Well, hold on there, cowboy. John, while we're on the topic of awesome podcast, you're going to be one of the co host of a new official podcast for ASCRS.
1:53.0	Want to tell us a little bit about that. Yeah, I sure am. So it's called gut check.
1:58.0	I was a little disappointed. They didn't choose my suggested name. So my suggested podcast name was where the sun always shines. So maybe I'll save that need for another time.
2:09.0	Yeah, we had a kickoff meeting last week. And we're going to be bringing you some really cool content in the coming months that can hopefully, you know, sort of supplement some of the colorectal specific content that you get from behind the knife.
2:22.0	All right. Let's get into our topic for today.
2:27.0	Tess, what are your thoughts about this topic?
2:30.0	I'm glad we're going to be talking about this today. This was something as a fellow and now as an attending that I find really challenging every patient with Crohn's is so different.
2:41.0	So first trying to figure out one, do they need surgery? Then once you've made that determination trying to figure out when it's going to be the safest window to do it in and how to optimize them can be really hard.
	...

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