Celiac disease surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ajay Gade MD[2]]

Overview

Surgery is not the first-line treatment option for patients with celiac disease. Surgery is usually reserved for patients with refractory or pre-malignant complications, such as Enteropathy Associated T-cell Lymphoma (EATL) and ulcerative jejunitis (UJ). EATL patients presenting with ulcerative lesions, stenotic lesions, and perforation needs surgical intervention. Surgery also serves as a pre-therapy treatment in order to prevent perforation of the small bowel during (chemo)therapy. After surgery patients receive immuno-, chemotherapy and/or stem cell transplantation van de Water JM, Nijeboer P, de Baaij LR, Zegers J, Bouma G, Visser OJ, van der Peet DL, Mulder CJ, Meijerink WJ (2015). "Surgery in (pre)malignant celiac disease". World J. Gastroenterol. 21 (43): 12403–9. doi:10.3748/wjg.v21.i43.12403. PMC 4649123. PMID 26604647..

Surgery

• The small bowel is resected either by a laparoscopic or a laparotomy procedure depending on the location, the setting (elective/acute) and the preference of the surgeon performing the intervention van de Water JM, Nijeboer P, de Baaij LR, Zegers J, Bouma G, Visser OJ, van der Peet DL, Mulder CJ, Meijerink WJ (2015). "Surgery in (pre)malignant celiac disease". World J. Gastroenterol. 21 (43): 12403–9. doi:10.3748/wjg.v21.i43.12403. PMC 4649123. PMID 26604647..
• Mobilization and transection of the bowel are performed and the involved segment resected if possible.
• Resectability is assessed peri-operatively and has three types radical, partial or unresectable. Radical resection is a complete resection of the tumor mass. partial resection is when only some but not all of the tumor mass is resected. Unresectability is the inability to resect any part of the tumor.

Indications

• Perforation
• Stenosis