Reasons for Crohn's Surgery
For most people with Crohn's, symptoms get worse over time. In emergency situations, surgery is the only option.
The most common reason for surgery in people with Crohn's disease is a partial bowel obstruction. An obstruction can get worse gradually or happen quickly and be an emergency.
"Segments of bowel in Crohn's disease go through cycles of inflammation and repair," Talamini explains. "Over time, these pieces of bowel become hard, like a lead pipe. People with obstructions may experience vomiting, distention, and abdominal pain when they eat." When bowel obstruction sets in, surgery is in order.
Other reasons for Crohn's surgery include a fistula, bleeding, perforation, or abscess.
Types of Surgery for Crohn's
There are two main surgeries for Crohn's disease: bowel resection and stricturoplasty. Both can be done laproscopically or through an open abdominal incision.
Bowel resection: A bowel resection involves removing the diseased part of the intestines. It is the most common operation for a bowel obstruction caused by Crohn's disease. It's also done to correct a fistula that doesn't respond to medication.
Colectomy: If Crohn's disease is severe and affects the colon, some people may need to have their entire colon removed, called a colectomy. In some cases, the small intestine can be connected to the rectum, so the person can pass stool normally.
Proctocolectomy: In some cases, both the colon and rectum will need to be removed. The surgeon also performs an ileostomy, which brings the end of the small intestine through a hole in the abdomen, called a stoma. Waste is collected in a bag attached to the stoma, which is emptied several times a day. The bag is hidden under clothing, so no one will see it.
Stricturoplasty: Stricturoplasty is done to open up narrowed areas of the small intestine. It doesn't remove any part of the small intestine. However, sometimes with strictures, a bowel resection may be necessary.
With surgery for Crohn's, surgeons aim to do as little as necessary to obtain the best results. "People with Crohn's disease tend to need multiple operations; therefore, we preserve as much bowel as we can each time," Talamini says.
A Question of Benefits and Risks
In most cases, Crohn's surgery is done to improve quality of life. "In these cases, we decide to do surgery only after weighing benefits and risks," Talamini says.
If you are considering surgery, make sure your gastroenterologist and surgeon work together to come up with the right treatment combination for you.
Both operations for Crohn's disease generally involve a few weeks of recovery. Like all surgeries, they also come with risks. "Surgery on the intestines can lead to complications such as leakage from the bowel; infection in the abdomen or surgical wound; blood clots in the extremities; or a temporary bowel blockage called an ileus," Vogel says.
In addition, some people may experience "short-gut syndrome." With this condition, the intestine is too short to absorb all the nutrients a person needs.