Surgery for Crohn’s Disease

Surgery is just one of many possible treatments for Crohn’s disease. But it’s a common one. Up to three-quarters of people with Crohn’s need surgery at some point, even when they take medicine and eat right.

Surgery can’t cure Crohn’s disease. But it can help you feel better and live more normally.

Why Consider Surgery?

You might need surgery to treat Crohn’s for several reasons.

Some problems the disease causes can be dangerous. This might happen if medications don’t work to control your symptoms. You may need surgery when your intestine:

  • Gets narrower or blocked because of scar tissue
  • Bleeds too much
  • Gets a hole in its wall
  • Has a fistula, a passageway between two organs that don’t normally connect
  • Is infected
  • Gets badly inflamed as part of a serious problem called toxic megacolon

You might also choose surgery if Crohn’s makes your day-to-day life difficult, or your medications cause lots of side effects.

Your doctor may also recommend surgery if you have serious Crohn's symptoms and are at high risk of getting colorectal cancer. These odds go up for people with Crohn's.

Types of Crohn’s Surgeries

There’s no one-size-fits all surgery to treat Crohn’s disease. The type you have depends on:

  • The reason you need surgery
  • How serious your Crohn’s is
  • What part of your digestive tract is affected

Here are some common types of Crohn’s surgeries:

  • Strictureplasty: Widens narrowed areas of your intestine that could lead to blockages. The surgeon doesn’t remove any part of your intestine.
  • Fistula removal: Closes, opens, removes, or drains a fistula that doesn’t heal with medication. Most fistulas in people with Crohn’s form either between two different parts of your intestine; the intestine and another body part like your bladder; or your intestine and your skin. Which surgery you need depends on where the fistula is.
  • Colectomy: Removes your colon when it's badly diseased, but leaves your rectum.
  • Proctolectomy: Removes your colon and rectum (together called the large intestine) when both are badly damaged.
  • End ileostomy: This kind of proctolectomy reroutes the end of your small intestine through a small hole in your belly, called a stoma. Waste then drains into an ostomy bag outside this hole.
  • Bowel resection: Removes part of your small or large intestine that’s been damaged by Crohn’s and connects the two healthy ends.
  • Abscess drainage: Your surgeon cuts into an infection in your belly, pelvis, or around your anus and puts in a tube to drain pus.
  • Ileostomy: Reroutes stool, either temporarily or permanently, through a hole in the belly called a stoma. You may get an ileostomy to let your intestine heal after another operation, to reduce inflammation, or so you can get another surgery on your rectum or anus. Stool drains into an ostomy bag or a special pouch your surgeon creates to connect to your anus.

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Risks and Benefits

Like surgery for any condition, Crohn’s procedures come with pros and cons. Complications can include:

  • Infections
  • Bleeding
  • Scarring that twists or narrows your intestine
  • Bowel obstruction, which blocks waste from moving through your intestine
  • Vitamin B12 deficiency, when your surgeon removes a part of your intestine that absorbs the vitamin
  • Stoma problems, such as when the opening changes, making it hard to attach the ostomy bag

Surgery doesn’t guarantee you won’t have more Crohn’s symptoms. About 30% of people who get surgery have symptoms again within 3 years, and 60% get symptoms again within 10 years.

But the benefits can outweigh the risks. Depending on which type of operation you’ve had, you can expect less pain and fewer symptoms like diarrhea, vomiting, or feeling tired. You might be able to take fewer medications or stop those that have lots of side effects. And you might be able to eat more kinds of food and gain weight more easily.

Recovering From Surgery

Just after you have Crohn’s surgery, you may take prescription medications to control pain and lower your chances of infection. You may stay in the hospital about a week or less depending on what type of surgery you had.

Even after you recover, you'll need to see your surgeon and gastroenterologist. They'll track any problems resulting from surgery and watch for Crohn’s symptoms. Depending on your type of surgery, you may have to change some of the things you eat, either for now or for good.

WebMD Medical Reference Reviewed by Neha Pathak, MD on November 10, 2020

Sources

SOURCES:

Crohn’s and Colitis Foundation: “Crohn’s Disease Treatment Options,” “Surgery for Crohn’s Disease,” and “Surgery for Crohn’s Disease and Ulcerative Colitis.”

National Health Service (UK): “Overview: Ileostomy.”

Crohn’s and Colitis UK: “Surgery for Crohn’s Disease.” 

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