Crohn’s disease, a form of inflammatory bowel disease, can occur anywhere throughout the gastrointestinal tract. Typically, treatment with medication is the first therapeutic option, however surgery becomes necessary when medications can no longer control symptoms. Seventy percent of people with Crohn’s disease will require surgery at some point during their lives. Different types of procedures may be performed based on the location and severity of the disease. The goals of surgery are to alleviate symptoms, remove only the affected bowel, and restore quality of life. Surgery for Crohn’s disease is not curative, it is focused on allowing the patient to recover without complications, prevent future operations, and restore quality of life.
Crohn’s Disease Surgical Procedures
There are several different types of surgical procedures for Crohn’s disease, depending on the location of the disease in your gastrointestinal tract and the symptoms causing the suffering.
In strictureplasty, narrowed areas or strictures in the small bowel are widened surgically to resolve the chronic blockage, without the need to remove that portion of the intestines. Several strictures may be treated in one surgery. Strictureplasty is not performed on colonic strictures.
Small and large bowel/colon resection
A bowel resection is the removal of the diseased portion of your small or large intestine. During the surgery, the damaged portion of your intestine is removed, and the two healthy ends are joined together. There can be multiple resections in one operation.
Bowel fistula and abscess treatment
In patients with fistulizing Crohn’s disease, or long-standing stricturing disease, connections between different organs can arise; these are called fistulas. While some fistulas can be treated with antibiotics and biologic medications, fistulas may persist and require surgical resection. Often, fistulas are associated with intra-abdominal abscesses. Based off the size of the abscess, antibiotics with/without a percutaneous drain (through the skin) can treat them. Typically, this is followed with an operation to remove the bowel that was responsible for the abscess.
Perianal abscess and fistula treatment
Abscesses and fistulas around the anus may occur in Crohn’s disease. Abscesses must be drained, which can typically be performed in the office, and antibiotics might be needed. In cases where the abscess returns or there is a history of previous abscess/fistula, an MRI might be needed. Small drains might need to be placed if there is a fistula, which is followed with an additional procedure to close the fistula. Occasionally, when there is extensive perianal disease, other surgical procedures are needed.
In patients with extensive Crohn’s disease, the colon, rectum or perianal disease, a proctocolectomy maybe needed. A proctocolectomy is the surgical removal of the colon, rectum and select patients may have a J-pouch created or an end ileostomy.
Occasionally, patients with Crohn’s disease need a temporary or permanent stoma. A stoma is when a piece of healthy intestine is attached to the abdominal wall and the patient wears a stoma bag that collects the stool. This is a potentially life-saving procedure and can give patients back their quality of life. In most patients, there is a plan to eventually reverse the stoma.
What should I look for in a surgeon?
When looking for a surgeon to treat inflammatory bowel disease, it’s important to find a colorectal surgeon who is board certified in colorectal surgery. There are techniques used in colorectal surgery that require the expertise and specialization of a colorectal surgeon. Having a colorectal surgeon with a sub-specialization in inflammatory bowel disease adds an even greater level of specialization with someone extensively trained in surgeries that relate to your Crohn’s disease.