Crohn’s Disease Surgery: Overview

Crohn’s disease, which is one form of inflammatory bowel disease (IBD), is sometimes treated with surgery. The number of patients who need surgery has lowered as medications have improved. It used to be estimated that around 75% of people with Crohn’s would need surgery, but now it’s thought to be closer to 25%.

There are several types of surgery used to treat Crohn’s disease. Which type of surgery is used and when will be based on a number of factors, including where the inflammation from Crohn’s disease is located and if there are any extraintestinal manifestations (complications) of the disease.

What Is Surgery for Crohn’s Disease?

Each type of Crohn’s disease surgery serves a different purpose. In some cases, surgery is used to remove inflamed or damaged parts of the intestine. In others, surgery might be needed to manage complications.

Surgery for Crohn’s disease may be done on an emergency basis or scheduled ahead of time. Keeping up with treatments and seeing a gastroenterologist on a regular basis is important in managing the disease. Proper management can help you avoid emergency situations with Crohn’s disease.

Various Surgeries

Abscess drainage: People with Crohn’s disease may be at a greater risk for abscesses. An abscess is when an infection causes a collection of pus. This might occur in the glands that surround the anus. Abscesses can be painful and difficult to cope with, so they might be drained to provide relief.

Colectomy: During a colectomy, the colon is removed. Some or part of the rectum is left.

If the colon is removed, stool will need to leave the body in another way. This procedure is done in one of two ways. One way is with an ileostomy, in which a piece of the small intestine is brought through an opening in the abdomen (called a stoma). The other way is called a straight pull-through. This is when the end of the small intestine is connected to the rectum.

Fistula repair: A fistula is an abnormal connection between two organs. That can be, for instance, the colon and the skin or the colon and the vagina. Fistulas can happen for various reasons, but in Crohn’s disease, they usually involve the intestines. 

There are different types of surgery used to treat fistulas. The procedure that’s used will depend on how extensive the fistula is and where it’s located. A colorectal surgeon will help in recommending which type of surgery might be done.

A fistulotomy, for instance, might be done for a fistula in or around the anus that goes to the skin. A fistulectomy might be used when there’s a more complicated fistula between two organs.

Ileostomy: An ileostomy is when a piece of the small intestine is brought through the abdomen and an appliance is worn over it to collect stool. It might be created after part or all of the large intestine is removed. An ileostomy can be temporary or permanent. 

Proctectomy: Proctectomy surgery is the removal of the anus and the rectum. The removal of these parts of the large intestine will mean that an ostomy is also created. A proctectomy might be done when Crohn’s disease affects the perianal area (the skin around the anus).

Resection: A resection is the removal of a piece of the small or the large intestine. The part that is inflamed or damaged is taken out. The two healthy ends of the intestine are then attached back together. 

Strictureplasty: A stricture is a narrowing in the intestine. This can occur because inflammation causes the wall of the intestine to thicken. It can also happen when the intestinal wall thickens because of scar tissue.

A narrowing can mean that a blockage is more likely. Opening up the stricture can be done surgically, and it doesn’t lead to a loss of any part of the bowel.

Contraindications

Surgery for Crohn’s disease is usually done when it’s clearly needed. In some cases, if a patient is quite ill, they might not be a good candidate for surgery. Crohn’s disease may lead to complications such as anemia (lack of healthy red blood cells to carry oxygen to the body's tissues) or malnutrition (lack of proper nutrition), which could make surgery and recovery more challenging.

Surgery may be delayed to give a patient time to heal and get into better shape for surgery. The risks of any surgery will be weighed against the benefits.

Surgeries to treat Crohn’s disease or its complications might be done in a variety of ways. A gastroenterologist and colorectal surgeon will go over the options.

Patients may want to ask about the possibility of laparoscopic surgery vs. open surgery for some procedures. In laparoscopic surgery, only small incisions are made and a camera guides the instruments along. In open surgery, a larger incision is made to access the area.

Potential Risks

The risks of each type of surgery will be different for each patient and each procedure. Patients should work with their surgeon and the rest of their team to understand the potential risks. Some of the risks for Crohn’s disease can include:

• Abscess
• Bleeding
• Bowel blockage (obstruction)
• Infection
• Readmission to the hospital
• Surgical adhesions
  

Purpose of Crohn’s Disease Surgery

The overarching reason for surgery for Crohn’s is to manage the disease. The type of surgery used will depend on the extent of the inflammation and any complications. As medications to manage the disease improve, fewer people are needing surgery.

How to Prepare

Preparing for surgery will depend on the type of surgery and the timing. In general, it’s important to understand the type of surgery, the potential complications, and what the recovery period will look like. 

For some surgery, preparing might mean cleaning out the bowel. This is similar to how you would prepare for a colonoscopy. Other types of surgery might need preparation that includes fasting, stopping certain medications, or taking antibiotics.

For those having surgery to place an ileostomy or a colostomy, the preparation will include information about managing a stoma. Meeting with an enterostomal therapy (ET) nurse will be important in deciding where to place the stoma on the abdomen.

After surgery, an ET nurse and other healthcare team members will give instructions on how to manage a stoma appliance.

What to Expect on the Day of Surgery

Depending on the type, there may be several meetings with members of the healthcare team before the day of surgery. This will help in getting questions answered about what will happen before, during, and after surgery.

Some types of surgery will require a stay in the hospital. The day of surgery will mean checking in to the hospital. Patients will have their vitals taken and meet with the surgical team. An IV (intravenous) drip will be started to give fluids and any needed medications before and after surgery, including anesthetic and pain medications. 

For outpatient surgery, there may be local medications given to numb the surgical area. The surgical site might also need preparation to prevent possible infection. 

Recovery

For many types of surgery, recovery will include pain management. For more extensive inpatient procedures, that might include IV medications.

For outpatient surgery, there could be prescription or over-the-counter oral pain medications. Patients should talk with their team to understand how to manage any pain after surgery.

For procedures such as a resection or ostomy surgery, patients will be managed in the hospital. Patients may have an IV, surgical drains, or a nasogastric (NG) tube in the nose. Diet may be started slowly, first with clear liquids and eventually progressing to a regular diet in preparation for being discharged to home. 

Long-Term Care

The long-term care will often include follow-up appointments with the gastroenterologist, the surgical team, and, in the case of ostomy surgery, an ET nurse. 

It’s important to understand how to care for any surgical sites at home. The healthcare team will give instructions, which might include keeping the site dry, changing dressings, or making a follow-up appointment to remove any staples that are used.

In the long term, patients should expect some relief from the symptoms for which they had the surgery. In some cases, that might also mean a change in medications and other treatments. While recovering, some patients may find that they can work with a dietitian to add more foods back into their diet.

Summary

Several types of surgery are used to treat Crohn’s disease. These include abscess drainage, colectomy, fistula repair, ileostomy, proctectomy, resection, and strictureplasty.

Some of these procedures may be done with minimally invasive laparoscopy, while others may be open procedures. They might be done as outpatient surgery or require a hospital stay.

A Word From Verywell

Surgery for Crohn’s disease is not curative, but it may offer a good option for managing symptoms and coping with any complications. Patients are often concerned about having surgery, but there is a potential for a good outcome that can improve your quality of life.

More medication options have meant that fewer people with Crohn’s disease are having surgery these days.