Editing Operations for crohn's disease (section)

== '''Pre-op''' ==

* Anti-TNF agents (infliximab, adalimumab, certolizumab) - a/w increased operative complications - controversial
** Ideally last dose >4/52 pre-op
** UC - possible a/w pelvic sepsis after IPAA - 3-stage approach favoured in patients on anti-TNF drugs
** CD - possible increase in complications, but controversial and not clear
** Vedolizumab 
*** Ideally last dose 4-8/52 pre-op
*** UC - no increased risk of infection
*** CD - similar rates of infection to anti-TNF drugs
** Ustekinumab
*** Similar complication rates to anti-TNFs
*** Ideally last dose 4/52 pre-op
** Restart 4/52 post-op where necessary
* Corticosteroids
** Well-established detrimental effect on anastomotic healing
** UC: should do delayed IPAA formation in patients who cannot be weaned to <20mg/day for 6/52 pre-op
** CD - high risk of infection is generally ameliorated by stoma instead of primary anastomosis
*** Should still be reduced if possible
* Nutrition
** UC - no pre-op TPN
** CD - poorly studied in biologic era, but no clear role for pre-op TPN
*** Still need to optimise nutrition
* Planning
** Pre-op imaging is crucial +/- capsule endoscopy
** Looking for important disease in other areas of GIT
** Planning extent of resection