Crohn's disease surgery: What to know
Surgery does not cure Crohn's disease, but it can reduce complications associated with the disease.
According to the United States' National Institute of Diabetes and Digestive and Kidney Diseases, an estimated 60 percent of people with Crohn's disease have surgery within 20 years of their diagnosis.
When is surgery an option for Crohn's disease?
Doctors may recommend surgery in severe cases of Crohn's disease.
Doctors typically prescribe medications and recommend dietary changes to help keep Crohn's disease flare-ups and symptoms to a minimum.
However, a person can still experience inflammation and other complications, especially if the disease is severe.
Surgery is invasive, so doctors will not usually recommend it unless 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 not reduced by other treatments
Doctors may also use surgery in emergency situations, such as a bowel obstruction. Researchers in one study estimate that 6 to 16 percent of people with Crohn's who present with acute symptoms require surgery.
There are several types of surgery that a doctor may recommend for Crohn's disease. These include:
Small bowel resection
This surgery removes a portion of the small intestine because of an obstruction or severe damage from Crohn's disease.
A doctor may be able to perform the surgery laparoscopically, meaning they will make a few tiny incisions and insert instruments that enable them to see the small intestine and remove the affected portion. At other times, a doctor may need to make a larger incision known as open surgery.
Subtotal colectomy is a surgery to remove all or a portion of the large intestine, also known as the colon.
Similarly to a small bowel resection, doctors may perform this surgery laparoscopically or via an open surgery method.
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.
Proctocolectomy and ileostomy
Image credit: Cancer Research UK, 2014
This surgery involves removing the entire colon and rectum. A surgeon will also bring a portion of the small intestine known as the ileum through an opening in the abdomen. This is known as an ileostomy.
A person will wear a plastic pouch over the opening known as an ostomy. They will need to change the bag frequently, as it collects stool throughout the day.
A doctor will try to preserve as much of the bowel as possible, which will aid the digestive function.
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.
What to expect
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 will experience some pain and discomfort.
Sometimes, they will receive nutritional support intravenously, such as total parenteral nutrition or 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.
Researchers estimate that one-third of people undergoing Crohn's disease surgery will experience post-operative complications.
A person is 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.
More severe complications include:
- Anastomotic leak: The area where doctors sew the two portions of intestine together is known as the anastomosis. This area is at risk for leakage of bowel contents if the pieces of intestine do not fuse together correctly. This 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, is another possible complication of Crohn's disease surgery. Low blood counts can impair the body's ability to heal, and can 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:
If a person with Crohn's disease is taking immunomodulators or other medications that can impair wound healing, recovery may be more challenging.
For this reason, doctors often recommend reducing these medications before surgery to minimize the risks.
A doctor can discuss potential recovery time before surgery.
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.
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.