Preoperative Optimisation for Elective Surgery in Crohn’s Disease

Crohn’s disease is a chronic inflammatory bowel disease and despite an increase in the available drug treatments, many patients still require surgery at some point in their disease course. Stricturing and penetrating phenotypes of Crohn’s disease are less likely to respond to our current medical treatment and therefore, surgical intervention may be required. This is most commonly elective, planned surgery, thereby affording the opportunity to optimise medications, nutritional and inflammatory status, steroid use. Poor nutritional status and previous surgery increase the risk of postoperative complications. Preoperative optimisation has three main goals: reduction of postoperative complications, reduction of reoperation rates and reduction of postoperative recurrence rates. In this narrative review, we examine the role of nutritional intervention, medical optimisation pre- and postoperatively and the role of personalised prehabilitation in the reduction of postoperative complications.