Surgical treatment of inflammatory bowel diseases and pregnancy

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doi:10.1016/j.bpg.2007.05.009 Copyright © 2007 Published by Elsevier Ltd.

Surgical treatment of inflammatory bowel diseases and pregnancy

andra Ilnyckyj MD, aSection of Gastroenterology, Faculty of Medicine, University of Manitoba, 409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada Ulcerative colitis (UC) and Crohn's disease (CD) affect women of reproductive age. Surgical intervention is often required. Therefore, the implications of disease treatment and pregnancy need to be understood. The standard surgery for UC is proctocolectomy, followed by ileal pouch anal anastomosis (IPAA). This review summarises the literature describing the effects of IPAA on gynaecologic and sexual health, fertility, pregnancy, labour and delivery. The emerging role of laparoscopic IPAA and the limited role of ileo-rectal anastomosis (IRA) are discussed. The experience with emergency surgery in pregnant women with ulcerative colitis is also presented. The literature explores two key issues of pregnancy in CD: the possible effect of pregnancy decreasing resection rates, and the optimal mode of delivery, especially in the setting of perianal CD. These two issues together with the available literature describing stoma function during pregnancy and the foetal outcome after surgical therapy are presented.

Key words: ulcerative colitis; Crohn's disease; surgery; ileo-anal pouch anastomosis; sexuality; fertility; pregnancy

Best Practice & Research Clinical Gastroenterology Volume 21, Issue 5, October 2007, Pages 819-834 Pregnancy-Related Gastrointestinal & Hepatological Diseases and Complications