Q:

The following statement(s) is/are true concerning the surgical management of Crohn’s disease

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The following statement(s) is/are true concerning the surgical management of Crohn’s disease.


  1. Strictureplasty, although offering short-term benefits, is associated with a higher rate of recurrence when compared to resection
  2. Frozen section examination of the margin of resection is essential to prevent both recurrent disease and early anastomotic complications
  3. Conservative margins of resection are appropriate, resecting only grossly involved segments of bowel
  4. Patients with Crohn’s disease confined to the colon may be treated with total proctocolectomy with construction of an ileal-anal pouch anastomosis

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c. Conservative margins of resection are appropriate, resecting only grossly involved segments of bowel

Surgical therapy for Crohn’s disease is curative not palliative, therefore is reserved for complications of the disease or failure of or debilitation, secondary to medical therapy. The lines of bowel resection should be chosen conservatively with only a few centimeters proximally and distally to the site of visible changes of Crohn’s disease. Microscopic evidence of Crohn’s disease at the resection margins does not compromise safe anastomosis and therefore frozen section examination of resection margins is not necessary. In patients with multiple strictures of the small bowel, resection may involve excessive resection of bowel. Therefore, strictureplasty is an appropriate surgical therapy. Long-term results using this approach indicate that recurrence rates are not substantially increased with strictureplasty, even though inflamed intestinal tissue is left in situ. In patients with diffuse disease of the colon or rectum, proctocolectomy with ileostomy is the treatment of choice. Both the risk of ileal involvement and transmural involvement of the rectum precludes the technique of ileal pouchanal reconstruction in patients with Crohn’s disease.

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