Leading US colorectal surgeon highlights changing role of surgery in IBD  

One of the key speakers at the Irish Society of Gastroenterology 2026 Summer Meeting was Prof Phillip Fleshner, Professor of Surgery and Director of Colorectal Surgery Research, Cedars-Sinai Medical Centre, Los Angeles, US, who attracted packed audiences to his presentations.

With more than 25 years’ experience in colorectal surgery, Prof Fleshner has authored over 250 peer-reviewed publications and is widely recognised as a leader in the field.

His research focuses on multidisciplinary approaches to optimising perioperative care, particularly in patients with inflammatory bowel disease (IBD). His work has helped define phenotypic subgroups in Crohn’s disease and ulcerative colitis, clarifying how these subgroups influence surgical outcomes and perioperative management strategies.

His additional research interests include improving surgical outcomes in IBD and evaluating the impact of perioperative immunosuppression on postoperative results.

During the meeting, Prof Fleshner delivered two lectures focusing on advances in IBD surgery and on translational perspectives at the intersection of gastroenterology and surgery in IBD.

Speaking on surgery for ulcerative colitis and Crohn’s disease, Prof Fleshner said procedures have progressed far beyond simple “ectomies”.

Increasingly, surgery is being used earlier in the disease course for treatment and control, and as a platform for mechanistic discovery rather than a last resort when other therapies fail.

“There are exciting new concepts arising in surgery in ulcerative colitis and Crohn’s disease that will further transform the surgical management of these diseases and lead to more personalised and more effective surgical therapy.”

Patient selection and individual disease assessment are key to optimising outcomes, Prof Fleshner noted, adding that the microbiome also plays an important role. Data indicate that the state of the microbiome at the time of surgery is an important predictor of recurrence, while “steroids are a disaster” for surgical outcomes, he told the meeting.

Prof Fleshner also explored the role of the mesentery and ‘creeping fat’ in IBD.

He discussed the conflicting evidence regarding optimal mesenteric excision strategies, which he suggested largely reflects differences in patient selection and study design.

Prof Fleshner also highlighted interest in the recently released MESOCOLIC trial results and its potential contribution to the evidence base.

In both his presentations, he stressed the importance of gastroenterologists, surgeons, and other members of the multidisciplinary team working together to improve outcomes for patients.

“The future will be precision medical and surgical IBD teamwork.”

Speaking to the Medical Independent, Prof Fleshner said the key takeaway from his talks was that clinicians need to “stop working in silos”.

“We need to work together. Not just surgeons and GI docs, not just the people in the lab; it is all of us working together.”