Crohn’s disease is an inflammatory bowel disease that damages the small and large intestines. A doctor may recommend Crohn’s disease surgery for a person with severe symptoms if other treatments are not helping.
Surgery does not cure Crohn’s disease, but it can treat complications associated with the disease. Many people with this condition have surgery alongside other treatments, such as medications.
This article explains the types of surgery for Crohn’s disease, including who it suits, complications, and recovery times.
Doctors
However, a person can still experience inflammation and other complications, especially if the disease is severe.
Surgery is invasive, so doctors usually recommend it only when it is absolutely necessary. Examples of these instances include if a person has:
- an abscess or pocket of infection
- a fistula
- intestinal bleeding
- intestinal obstructions
- irreversible intestinal damage
- symptoms that do not respond to other treatments
Doctors may also use surgery in emergency situations, such as a bowel obstruction. A
The authors suggest the risk of needing surgery may increase due to factors such as smoking or discontinuing medication.
A doctor
Segmental resection
A segmental resection involves removing part of an organ. A surgeon may perform this type of surgery on various organs.
The following surgeries are examples of segmental resections that a person with Crohn’s disease may have:
- Small bowel resection: removing a portion of the small intestine
- Partial or subtotal colectomy: removing part of the colon
- Proctectomy: removing part of the rectum
A doctor may be able to perform the surgery laparoscopically. This means they will make a few tiny incisions and insert instruments that let them see the organ and remove the affected portion.
At other times, a doctor may need to make a larger incision, which is known as open surgery.
Complete resection
A complete resection will remove the entire affected organ. Someone with Crohn’s disease may require a total proctocolectomy, which involves removing the colon and rectum.
This procedure may require an ileal pouch-anal anastomosis (IPAA), or J-pouch surgery. This aims to restore gastrointestinal continuity by creating a small J-shaped pouch with part of the small intestine.
A total proctocolectomy with IPAA is a
Some people may receive a revised diagnosis from ulcerative colitis to Crohn’s disease following the procedure.
However, this is not common and can occur when people have new or recurrent symptoms or evidence to suggest the initial presentation was Crohn’s disease that initially presented in the colon only.
Stricturoplasty
This surgical procedure involves widening the small intestine to reduce narrow areas where it is difficult to pass stool.
However, the strictures, or narrow areas, must be limited to a small portion of the bowel to avoid removing a portion of the small intestine.
Fistulotomy
This procedure removes an anal fistula. An anal fistula can make it difficult or impossible to pass stool. Doctors usually perform this surgery on an outpatient basis, meaning a person does not stay in the hospital overnight.
Doctors perform Crohn’s disease surgery while a person is under general anesthesia. This means the patient is asleep and will not feel pain during the procedure.
Immediately after the surgery, a person may experience some pain and discomfort.
Sometimes, they will receive nutritional support intravenously, such as total parenteral nutrition (TPN). This is because the bowel needs time to rest and heal after surgery.
After the recovery time, a person will often begin eating again with a liquid or low fiber diet that is easy to digest. A doctor, dietitian, or both will help the individual make further changes in their diet that may be necessary.
Potential complications of surgery for Crohn’s disease include:
- Anastomotic leak: The area where doctors sew the two portions of intestine together is the anastomosis. This area is at risk for leakage of bowel contents if the pieces of intestine do not fuse correctly, which can cause severe infection and illness.
- Surgical site infection: An infection in the gastrointestinal tract or abdomen can cause pain, swelling, fever, and many other symptoms.
- Bleeding: Bleeding, especially at the anastomosis, can occur. Low blood counts can impair the body’s ability to heal and sometimes be life threatening. A person may require blood transfusions if their blood counts are too low.
Other complications associated with Crohn’s disease surgery include:
- damage to surrounding structures
- pneumonia
- scarring, which can lead to bowel blockages
- skin irritation
- blood clots
If a person with Crohn’s disease is taking immunomodulators or other medications that can impair wound healing, recovery may be more challenging. A doctor may recommend reducing these medications before surgery to minimize the risk.
Risk level
According to a 2018 article, people with Crohn’s disease or ulcerative colitis may have a higher risk of postoperative complications than those with other bowel conditions. Factors involved in this risk may include:
- anemia
- malnutrition
- use of corticosteroids or other immunosuppressants
- the inflammatory disease process
- intraabdominal abscess
A person may also be at higher risk of complications if they are having emergency surgery because the body may already be affected by infection, dehydration, low blood counts, or other factors.
The length of recovery depends upon the surgery type and the person’s overall health before surgery.
The more invasive and lengthy the surgery, the longer the healing time tends to be. A doctor should discuss these considerations, as a person will likely need to make arrangements with work or school and limit their physical activity while they recover.
Surgery for Crohn’s disease does not cure this condition. Instead, it helps a person manage their symptoms and can help prevent potentially life threatening side effects.
A person will likely experience new areas of inflammation where they did not previously.
Crohn’s disease surgery is one way to treat damage from the disease and reduce risks for harmful effects.
Types of surgery include small bowel resection, subtotal colectomy, and stricturoplasty. Procedure and recovery times depend on the type of surgery.
A doctor will typically recommend surgery only when it is absolutely necessary. While surgery does not cure Crohn’s disease, it can help reduce the risks of complications, such as severe infections.