bowelpreserving

Bowel-preserving refers to medical and surgical approaches aimed at treating diseases of the bowel while preserving as much bowel length and function as possible. The objective is to avoid or minimize resection of healthy intestine, thereby reducing the risk of short bowel syndrome, maintaining continence, and preserving nutrient absorption. Bowel-preserving strategies are used in colorectal surgery, inflammatory bowel disease, and select acute presentations when feasible.

In colorectal cancer, bowel-preserving treatment may involve local excision or endoscopic resection for carefully selected early-stage tumors. Techniques such as transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), as well as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), aim to remove tumors with clear margins while avoiding segmental colectomy. Neoadjuvant chemoradiation may shrink rectal tumors to enable sphincter-sparing resections rather than permanent stomas.

In inflammatory bowel disease, bowel preservation includes approaches that widen treatment options beyond extended bowel resection. This encompasses stricturoplasty for Crohn’s disease to widen narrowed segments, limited resections when possible, and careful reconstruction to maintain overall bowel length. In some cases of obstruction or ischemia, non-resection or organ-sparing interventions are prioritized when safe.

Outcomes of bowel-preserving strategies depend on disease location, stage, and patient factors. Benefits include preserved bowel length, better quality of life, and reduced stoma use, but risks include potential undertreatment, higher local recurrence in oncologic cases, and the need for additional procedures. Multidisciplinary evaluation and careful patient selection are central to these approaches.