What are the pros and cons of Crohn's disease surgery? Here’s information about surgery you can use when talking to your doctor about treatment options for Crohn’s disease.
What is Crohn's disease?
Crohn's disease is a chronic illness in which the intestine, or bowel, becomes inflamed and marked with sores, or ulcers. Along with ulcerative colitis, Crohn's disease is part of a group of diseases known as inflammatory bowel disease (IBD).
Crohn's disease most commonly affects the lower part of the small intestine known as the ileum. It can, though, occur in any part of the large or small intestine, stomach, esophagus, or even the mouth. It can occur at any age, but it's most common between the ages of 15 and 30.
What are the symptoms of Crohn's disease?
People with Crohn's disease experience periods of severe symptoms. These are followed by periods with no symptoms when the disease is in remission. With Crohn's disease, remission can last for weeks or even years. Unfortunately, there is no way to determine when a remission will occur or when symptoms will return.
The symptoms of Crohn's disease depend on where the disease occurs in the bowel. They also depend on how severe the disease is. In general, symptoms can include:
How is Crohn's disease treated?
There is no cure for Crohn's disease. Treatment is determined by the severity and location of the disease. Because the disease can sometimes go into remission on its own, it's not always possible to determine whether a specific treatment has been effective.
When Crohn's disease is active, treatment has three objectives:
- Immune-suppressors, including:
- Anti-TNF blockers
For people with nutrition problems, supplements are often prescribed.
Two-thirds to three-quarters of people with Crohn's disease will eventually need surgery to treat their illness. There are several reasons why surgery might be needed:
- The medications are not working to control symptoms or do not work effectively enough.
- The drug side effects are unbearable.
- The person has serious complications that only surgery can correct.
What are the complications of Crohn's disease that might require surgery?
Patients who have the following complications of Crohn's may need surgery:
- The formation of a stricture (a scar), which is a narrowing in the bowel that can cause obstructions (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, is severely stretched out and toxins spread through the blood.
What kinds of surgery 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 medications, 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.
Many people are wary of having surgery to treat Crohn's disease. Each part of the intestines serves a particular purpose and removing part of the bowels may impair bowel function, leading to diarrhea or malnutrition. Also, surgery is not for everyone. It is best to collect as much information as possible and to consult closely with the appropriate health care professionals to determine the best possible treatment.
Here are the kinds of surgery that are done:
- 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 surgery 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 sewn 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 sewn together.
- Colectomy. Colectomy is the removal of the entire colon. This surgery might be done if the disease is severe and extensive enough. 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 both the rectum and colon are affected, both are removed with a surgery called a proctocolectomy. A proctocolectomy is performed along with an ileostomy. The latter surgery 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 throughout 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 lessened by taking medication to reduce inflammation. These medications include drugs that contain 5-aminosalicylic acid (5-ASA agents, like aspirin but designed to work in the intestintes) or drugs that manipulate the immune system response. These drugs are known as 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 surgery.
Are there other times when surgery is used to treat Crohn's disease?
A person with Crohn's disease who has developed a fistula or an abscess may need surgery. Fistulas, the abnormal passageways, may first be treated with medication. But if drugs do not help the fistulas to close, then the patient will need a bowel resection (removal of the problem area) and anastomosis (reconnection of the normal bowel).
In order to heal an abscess, the pocket of infection usually must be drained. The patient will have a computed tomography (CT) scan to let the doctor locate the abscess. In some cases, the pus can be fully drained with a tube place through the skin. In many cases, however, surgery is needed to treat the abscess.