OPERATIVE APPROACHES TO CROHN'S DISEASE AND RELAPSE PREVENTION

Аннотация

This article discusses the clinical course of Crohn's disease, diagnostic options, types ofsurgical approaches and theireffectiveness, as well as ways to prevent postoperative relapses. The course of the disease with persistent inflammation, the high risk of recurrence, andtheneed foran individualapproach to each patient are analyzed. Keywords: Crohn's disease, enteritis, surgical treatment, recurrence, intestine, laparoscopy, immunosuppressivetherapy. 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 allowfor relapse control In cases refractory to gastroenterological treatment or complicated by complications, surgical intervention is inevitable. However, after surgery, the likelihood of disease relapse ishigh, which requires continuousclinical, laboratory andinstrumental monitoring. Mainpart: 1. Clinical course and diagnosis: Crohn's disease usually begins with abdominal pain, chronicdiarrhea, weight loss, fever, anemia and other general symptoms. The terminal ileum andascending colon are most often affected. Diagnosticmethods:  Colonoscopyand biopsy(granuloma detection);  Computedtomography (CT enterography);  Blood tests (CRP,ESR, anemia);  Capsuleendoscopy. 98,7:ROTCAFTCAPMI.SECNEICSLACIDEM ,5202 ,lirpA,5emuloV gro.srehsilbupcimedaca.www 2.Surgical approaches: Surgery cannot completely cure Crohn's disease, but it is important in eliminating complications. Indications:  Narrowing oftheileum;  Abscess and fistulas;  Intestinal obstruction;  Perforation;  Gastrointestinal bleeding. Operationsperformed:  Bowel resection (segmental orsubtotal);  Stricturoplasty(widening ofthestricture);  Abscess drainage;  Closureoffistulas. Minimally invasive approaches: Laparoscopic methods - shorten the patient's recovery period, reducetherisk of infection and relieve pain. 3. Relapse prevention: The disease can recur even after surgery. Therefore, the patient mustbeunder constant observation. Relapseprevention is basedon: Immunosuppressivetherapy (Azathioprine, Methotrexate); Biological therapy (Infliximab,Adalimumab); Diet and healthy lifestyle; Colonoscopyat least oncea year. Some studies show that starting biological therapy within 1 year after surgery reduces the risk ofrelapse byupto60%. 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, especiallylaparoscopy, are oneoftheachievements in thisfield. 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 byupto 70%.