Surgery for Crohn’s disease used to be considered a last-resort treatment option and was only offered after all other treatments were tried. “As a result, doctors who sent people with Crohn’s for surgery felt like they’d failed — that’s no longer true,” says Raymond Cross, MD, co-director of the Digestive Health Center at the University of Maryland Medical Center in Baltimore. “Today, many doctors believe that surgery for Crohn’s is an option that should be explored. Any time I see a person with Crohn’s disease, I bring it up.”
Fortunately, with the advent of newer medications that offer better control of Crohn’s, the need for surgery has been reduced in some cases, says Miguel Regueiro, MD, co-director and clinical head of the University of Pittsburgh Medical Center's Inflammatory Bowel Disease Center in Pennsylvania. However, Dr. Regueiro adds that surgery for Crohn’s is still very common, with an estimated two-thirds to three-fourths of all people with Crohn’s needing surgery at some point as part of their treatment. Although surgery can’t cure Crohn’s, surgical procedures can ease symptoms and provide long-term relief.
When Surgery for Crohn’s Is Recommended
Doctors are most likely to recommend surgery for Crohn’s if medications don’t work or stop working, or if you develop any of these complications:
- A perforation or hole in your bowel
- A blockage or a stricture (narrowing of the bowel)
- A fistula (an abnormal passageway)
- An abscess
Some of these complications may require emergency surgery. Surgery may also be recommended to reduce the risk for cancer, which is increased by the chronic inflammation caused by Crohn’s.
Common Surgeries for Crohn’s
Crohn’s can affect any part of the gastrointestinal tract, although most typically the small intestine and colon are affected. Different types of surgical procedures for Crohn’s exist depending on the complication you’re having, where it's located, and the severity of your disease.
Surgical options for Crohn’s include:
- Strictureplasty. Over time, chronic inflammation from Crohn’s can scar your intestines. The scarring can cause a narrowing of the intestine (known as a stricture) or a blockage. If the or narrowing or blockage occurs in one of the lower sections of your small intestine (the jejunum or ileum), your doctor may recommend a strictureplasty — a surgery that involves cutting open the narrowed segment of bowel and stitching the tissue crosswise to widen it. None of the intestine is removed, which lowers the risk for complications.
- Fistulotomy. Up to half of all adults with Crohn’s will develop a fistula, a collection of intestinal bacteria that penetrates the wall of the gastrointestinal tract and forms a channel or loop in a nearby organ, such as the bladder, the skin, or, in women, the vagina. If antibiotics don’t resolve the problem, you may need this surgery to drain the infection and stop it from spreading.
- Bowel resection. A bowel resection involves cutting out the section of bowel that’s diseased and reattaching the healthy ends. A bowel resection is used to treat strictures and bowel perforations.
- Colectomy and proctocolectomy. During a colectomy, the surgeon removes the entire colon. During a proctocolectomy, the surgeon removes the colon and rectum. A proctocolectomy requires an ileostomy, which creates an opening for stool to pass out of the body and requires that you wear an ostomy bag to collect it. Concern about having to live with an ostomy bag is normal, but after you adjust to it, you can resume your normal activities, and other people won’t know unless you choose to tell them. Your doctor may recommend a colectomy if your entire colon is affected by Crohn’s. You may need a proctocolectomy if your rectum is involved, however this is less common.
Minimally Invasive Surgery for Crohn’s
Today, many surgeons are able to perform surgical procedures for Crohn’s using minimally invasive techniques, which reduces post-operative pain and the risk for complications, including infection, and allows for a faster recovery. “In the old days, people who underwent surgery for Crohn’s had a scar from their sternum to their pelvis,” Dr. Cross says. With minimally invasive or laparoscopic techniques, the incisions are much smaller and the cosmetic result is much better.
Laparoscopic procedures are best for people with Crohn’s who aren’t obese and who haven’t had previous abdominal surgeries. If your surgery is an emergency, your doctor may not be able to use minimally invasive techniques.
The Risks of Surgery for Crohn’s
Surgery for Crohn’s is generally safe and effective, and the results are usually good. It can dramatically reduce symptoms that may have limited your life before; “Almost everyone gets better with surgery,” Cross says.
Still, every surgery has its risks, including those associated with anesthesia and possible bleeding and infection. Strictureplasty sometimes leads to a serious condition called short bowel syndrome, which prevents the absorption of water, vitamins, and other nutrients from the food you eat. This can cause you to become dangerously dehydrated and lose significant weight. Short bowel syndrome can be treated with nutritional support and medications, but it may require an intestinal transplant.
People who undergo a bowel resection often require further surgeries down the road. “Within five years, 50 percent of people who undergo a bowel resection will come back because they’re having recurring symptoms,” Regueiro says. The inflammation they feel commonly reappears adjacent to where they had their surgery. “Why this happens is the mystery of why Crohn’s happens at all,” he notes. Some people may need two or more additional surgeries.
But this shouldn’t stop people with Crohn’s who need the surgery from having it, Regueiro says. If you have advanced or deep-seeded disease, he recommends seeing a surgeon about a bowel resection. Medications used for Crohn’s, particularly biologics, have been shown to slow the rate of symptom recurrence after surgery. Work with your doctor to develop a post-operative treatment plan. “It’s your doctor’s job to help keep you from getting sick again,” he says.
Is Surgery for Crohn’s Right for Me?
If surgery for Crohn’s has been recommended to you, ask your doctor to go over the risks and benefits in detail. If you decide to have surgery, do your best to care for yourself physically and mentally before your procedure, and build a support team of people who will help you before and after to prepare meals and manage other responsibilities while you’re recovering.