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OPERATIVE APPROACHES TO CROHN'S DISEASE AND RELAPSE
PREVENTION
Murtazayeva Xadicha Nuriddinovna
Teacher of Termez branch Tashkent medical academy
Turdialiyeva Umida Abdujabbarovna
Student of Termez branch of Tashkent Medical Academy
Safarov Firdavs Shuxratovich
Student of Termez branch of Tashkent Medical Academy
Abstract
: This article discusses the clinical course of Crohn's disease, diagnostic options,
types of surgical approaches and their effectiveness, as well as ways to prevent postoperative
relapses. The course of the disease with persistent inflammation, the high risk of recurrence,
and the need for an individual approach to each patient are analyzed.
Keywords
: Crohn's disease, enteritis, surgical treatment, recurrence, intestine, laparoscopy,
immunosuppressive therapy.
Introduction (relevance):
Crohn's disease is a chronic, relapsing granulomatous
inflammatory disease affecting the entire gastrointestinal tract, which has been increasing in
frequency in recent years all over the world, including in Uzbekistan. The disease is usually
diagnosed in young patients (15–35 years old) and sharply reduces the quality of life. 75%
of patients with Crohn's disease require surgery. However, the high rate of relapse (50-80%)
reduces the quality of life of patients. Modern surgical methods (Kono-S anastomosis) and
biological therapy allow for relapse control
In cases refractory to gastroenterological treatment or complicated by complications,
surgical intervention is inevitable. However, after surgery, the likelihood of disease relapse
is high, which requires continuous clinical, laboratory and instrumental monitoring.
Main part:
1. Clinical course and diagnosis: Crohn's disease usually begins with abdominal pain,
chronic diarrhea, weight loss, fever, anemia and other general symptoms. The terminal ileum
and ascending colon are most often affected.
Diagnostic methods:
Colonoscopy and biopsy (granuloma detection);
Computed tomography (CT enterography);
Blood tests (CRP, ESR, anemia);
Capsule endoscopy.
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2. Surgical approaches:
Surgery cannot completely cure Crohn's disease, but it is important in eliminating
complications.
Indications:
Narrowing of the ileum;
Abscess and fistulas;
Intestinal obstruction;
Perforation;
Gastrointestinal bleeding.
Operations performed
:
Bowel resection (segmental or subtotal);
Stricturoplasty (widening of the stricture);
Abscess drainage;
Closure of fistulas.
Minimally invasive approaches: Laparoscopic methods - shorten the patient's recovery
period, reduce the risk of infection and relieve pain.
3. Relapse prevention:
The disease can recur even after surgery. Therefore, the patient
must be under constant observation. Relapse prevention is based on:
Immunosuppressive therapy (Azathioprine, Methotrexate);
Biological therapy (Infliximab, Adalimumab);
Diet and healthy lifestyle;
Colonoscopy at least once a year.
Some studies show that starting biological therapy within 1 year after surgery reduces the
risk of relapse by up to 60%.
Conclusion
: Crohn's disease is a severe and difficult-to-control chronic inflammatory
disease, and surgical approaches are aimed only at eliminating complications. Since the risk
of recurrence after surgery is high, long-term patient follow-up, individualized therapy plan,
and early initiation of biological therapy provide effective relapse prevention. Modern
surgical techniques, especially laparoscopy, are one of the achievements in this field.
Surgical approaches in Crohn's disease eliminate complications of the disease, but
comprehensive measures are required to prevent relapse. Improvements in surgical
techniques (e.g., wider mesenteric resection), biological drugs, and smoking cessation can
reduce relapse by up to 70%.
References
:
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1.
Rutgeerts P. et al. “Approach to the surgical treatment of Crohn’s disease.”
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ECCO Guidelines on Crohn’s disease, 2020.
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Amaliyot, 2022.
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Abbasov Sh.A. “Jarrohlik amaliyotida ichak kasalliklari”, Toshkent, 2020.
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