Surgery for Crohn’s disease
There is no cure for Crohn’s disease, and if other approaches for reducing symptoms have not been effective, an operation may be recommended.
Operations for Crohn’s disease include a resection to remove the inflamed area of the intestine or an ileostomy to divert digestive waste away from the inflamed sections as a temporary measure to allow the inflamed area to heal.
What are the complications of Crohn's disease that might require surgery?
Patients who have the following complications of Crohn's may need surgery:
- An obstruction or blockage in the bowel
- The formation of a stricture, which is a narrowing in the bowel that can cause blockages
- Extensive bleeding in the intestine
- A hole, or perforation, in the bowel wall
- The formation of a fistula, which is a connection between two parts of the body that do not normally connect
- The formation of an abscess, which is a pocket of pus caused by infection
- A condition known as toxic megacolon, in which the colon, or large intestine, rapidly becomes severely dilated, and dangerous inflammation or infection occurs at the same time.
What kinds of operations are performed to treat Crohn's disease?
Surgery to treat Crohn's disease depends on several factors:
- Where the disease is located in the intestines
- How severe the disease is
- The purpose of the surgery - which complication it will treat
It's important to note that surgery, like drugs, does not cure Crohn's disease. After the diseased part of the bowel is removed, Crohn's can reappear in some other part of the intestine or elsewhere.
Surgery is not for everyone. It is best to collect as much information as possible and to consult closely with the appropriate healthcare professionals to determine the best possible treatment.
Here are the kinds of operations that are performed:
- Strictureplasty. Crohn's disease in the small intestine often shows up in alternating areas of the bowel. As a result, a diseased portion of the bowel is connected to a disease-free portion. Strictureplasty is a surgical procedure to widen the narrow area of the small intestine in a portion that is affected by the disease. No part of the intestine is removed.
- Resection. Resection is a surgical procedure in which part of the intestine is removed. This operation may be necessary when the stricture is very long. It may also be necessary when there are many strictures located near each other. The remaining healthy bowel sections are sewed together to create what's called an anastomosis. The removal of the diseased portion of the bowel may provide the patient with relief from symptoms for many years. But the disease can come back at or near the point where the two sections of bowel are sewed together.
- Colectomy. Colectomy is the removal of the entire colon. This operation might be done if the disease is severe and extensive. It may be possible to connect the rectum to the small intestine - ileum - if the rectum is not affected by Crohn's disease.
- Proctocolectomy. If the rectum and colon are affected, both are removed with an operation called a proctocolectomy. A proctocolectomy is performed along with an ileostomy. The latter operation brings the end of the small intestine through a hole in the lower abdomen so that waste can exit the body. The hole is called a stoma. When this procedure is necessary, the waste drains into an external bag that has to be emptied during the day. The bag or pouch is concealed by clothing and is not noticeable.
In about half of adults who have a resection to treat Crohn's disease, the disease recurs (comes back) within five years. The recurrence is normally near the site of the joining of two sections of healthy bowel - anastomosis - or at the site of the ileostomy.
The risk of recurrence may be reduced by drugs that reduce inflammation. These include those that contain 5-aminosalicylic acid (5-ASA agents) or that manipulate the immune system response, called immunomodulators. Often, recurrent Crohn's disease requires treatment that involves only medication. But about half of those who experience recurrent Crohn's disease will require another operation.