Surgical Outcomes in Inflammatory Bowel Disease Patients and the Potential Impact of Biologic Therapies

The decision to proceed with surgery in an inflammatory bowel disease (IBD) patient is ideally a collaborative effort between the patient, gastroenterologist, and surgeon. Unlike emergency situations where surgery is required to address significant complications of the underlying disease, either ulcerative colitis (UC) or Crohn's disease (CD), elective cases often allow optimizing patient or disease factors in an attempt to improve surgical outcomes. Numerous factors contribute to success after IBD surgery. A detailed description of the pre-, intra-, and postoperative patient and procedure-specific risk factors associated with contributing to or reducing postoperative complications is beyond the scope of this monograph. However, a unique factor often encountered in IBD patients is their long-term immunosuppressive medication use in the perioperative period. They might be on a single agent. However, often they are on multiple medications with different modes of action. In this article, we will review the evidence regarding the impact of immunosuppressive medications commonly used in the treatment of IBD patients with an in-depth consideration of the newer antibody-based therapies.