Surgery for Crohn's disease can change your life.
"Surgery gets rid of the diseased bowel," says surgeon Jon Vogel, MD, of the Cleveland Clinic. It can help you eat and drink without pain. You may also be able to stop taking Crohn's drugs, at least for a while. Almost 3 out of 4 people with Crohn's get surgery at some point.
There are also things surgery can't do.
"Surgery doesn't cure Crohn's disease," says Mark Talamini, MD, chairman of surgery at the University of California at San Diego. And your symptoms will likely come back at some point. Half of people who have one surgery need at least one more.
Who Should Have Crohn's Surgery?
You are most likely to need surgery because part of your bowel becomes blocked. "Segments of bowel in Crohn's disease go through cycles of inflammation and repair," Talamini says. "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." If the blockage worsens quickly, you will likely need emergency surgery.
You may also get surgery if you have:
- A fistula - a tunnel that forms in your intestine or between your intestine and another organ, like your bladder
- Bleeding in your gut
- A hole in your bowel
- An abscess -- a cavity of pus that can form near your anal area or elsewhere
Types of Crohn's Surgery
Surgeries for Crohn's include:
Bowel resection. This removes a diseased part of your intestine or corrects a fistula that doesn't respond to drugs.
Stricturoplasty. This common surgery opens up narrowed areas of the small intestine. Though it doesn't remove any intestine, you may also need a bowel resection.
Colectomy. If your Crohn's is severe and affects your colon, it may need to be removed. In some cases, the surgeon can connect the small intestine to your rectum, so you can still pass stools in a normal way.
Proctocolectomy. Sometimes both the colon and rectum need to be removed. The surgeon also brings the end of your small intestine through a hole in your belly, called a stoma. Waste passes through it into a bag, which you will need to wear and empty throughout the day. The bag is hidden under clothing, so no one sees it.
Your surgeon will aim to do as little as needed for 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.
Risks of Crohn's Surgery
People with Crohn's often choose to get surgery to make their day-to-day life better. "In these cases, we decide to do surgery only after weighing benefits and risks," Talamini says.
Risks include leaking from your bowel, infection in your belly or near the wound from surgery, blood clots in your hands or feet, and short-term blockage in your bowel. You could also get "short-gut syndrome." This means your intestine is too short to absorb all the nutrients you need.
Advances in Crohn's Surgery
Crohn's surgery used to mean getting a long cut in your belly so the surgeon could reach your organs. It could take 6 weeks to heal. Today, surgeons insert a laparoscope into your belly through a small cut. It has a tiny camera on the tip, so the surgeon can see inside your body.
"Typical procedures take 1 to 3 hours and require 3 to 7 days of recovery in the hospital," Vogel says. You can likely return to your normal life in just a few weeks.
"These new techniques are safe and effective," Vogel adds. "And they are constantly being refined to limit post-op pain and shorten hospital stays."
Most people with Crohn's are good candidates for laparoscopic surgery. You may not be if you have had many operations and have scar tissue in your belly.
Crohn's surgery isn't just for old people. "People with Crohn's disease are typically young and ramping up their careers and lives," Talamini says. "Having the option of surgery that is less invasive (physically, socially, and professionally) is important."