Surgical algorithm for inflammatory bowel disease. Manual. ABBVIE Sdn Bhd, Petaling Jaya, Selangor. (2016)
Abstract
In developed countries, with a high prevalence of inflammatory bowel disease (IBD), surgical management is performed by colorectal surgeons specializing in IBD surgery. There are significant limitations to achieving this in Malaysia. General surgeons number 1 per 100 000 population, and there are approximately 50 colorectal surgeons in the country, of whom about half are in public hospitals. This severely limits access to care for the socioeconomically challenged patient population. Very few surgeons have received specific training in the recognition and surgical management of IBD. Furthermore, given the low prevalence, it is difficult to gain expertise in managing these patients. Surgical expertise is most likely to develop in tertiary referral centres having gastroenterologists with an interest in IBD. In such centres, indications and management follow similar protocols to those in high-prevalence countries. Laparoscopic techniques are available for suitably selected cases, but incur significantly higher costs. Similar to the West, the majority requiring surgery are Crohn’s rather than ulcerative colitis, the former often requiring multiple surgeries. Nonetheless, there are significant obstacles and differences. Many are high-risk for surgery, presenting in emergent or complicated states, such as intestinal perforation/obstruction, infective complications, toxic megacolon or even malignancy. They may exhibit the side effects of long-term steroid use and nutritional deficiencies, further compromising chances of surgical success. Furthermore, many patients are reluctant to undergo surgery for a multitude of reasons, including fear of surgical complications, stoma-aversion and financial constraints. As such, even in a referral centre, the number of surgeries for IBD per year rarely exceeds 15-20. The keys to improving surgical management of IBD will be early multidisciplinary management, with centralization of specialized surgical services, and retention of such services within the public healthcare system. The surgical algorithms proposed in this guide are by no means exhaustive, but aim to aid decision-making for surgeons who do not have access to such centralized services.
| Item Type: | Monograph (Manual) |
|---|---|
| Keywords: | Surgical algorithm, Dysplasia, Ulcerative Colitis, Crohn’s Disease |
| Taxonomy: | By Subject > Applied Sciences > Biology |
| Local Content Hub: | Subjects > Applied Sciences |
| Depositing User: | Mohd Ismail Zanudin |
| Date Deposited: | 02 Jun 2021 11:51 |
| Last Modified: | 02 Jun 2021 11:51 |
| Related URLs: |
Actions (login required)
 |
View Item |