Surgery for Crohn’s Disease
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 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 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.