The future of surgical management of inflammatory bowel disease

IBD is a complex genetic disorder that will be treated using medical and surgical therapies that are specifically tailored for the individual patient using patient defined genetic and metabolic determinants of disease. The disease's pathophysiologic complexity will defy the rapid discovery of a simple, all encompassing cure. These patient defined genetic and metabolic factors will help determine the type and timing of surgery, its prognosis, and risk. The malignant risk of IBD will be more accurately defined and the timing of surgery determined using tests other than colonoscopy. Continued improvements in minimally invasive techniques of surgery will offer the IBD patient rapid relief of complications of disease with the least disability and stress. Fundamentally, the paradigm of care for the future will require the recognition that both surgical and medical therapies will need to be chosen in concert with the purpose of providing the best therapy for that individual patient at that point in their disease history in order to maximize response while minimizing long-term recurrence.