Surgery for Crohn’s Disease (Abdominal/Intestinal)

By Dr. Ahmer Karimuddin

Crohn’s disease is an autoimmune disease that can cause inflammation in any part of your digestive or gastrointestinal tract. (What Is Crohn's Disease?) In the early stages of Crohn’s, medication may be recommended to manage symptoms. But if medication is not sufficient or complications arise from the progression of the disease, surgery may become necessary.

Though surgery for Crohn's disease is a last alternative, it should be considered an important part of the overall treatment when needed. Approximately three of every four people with Crohn’s will have at least one surgical procedure during their lifetime. About half of those will undergo another surgical procedure at some future point. Though surgery is not a cure for Crohn’s disease, many people find that their quality of life improves significantly following surgery.

Surgery for abdominal/intestinal Crohn’s disease is most commonly recommended when there is significant bleeding, bowel blockages (obstructions), a perforation or hole in your bowel, or cancer. Surgery may involve removing a portion of the intestine that is inflamed or in some cases involves removing an entire organ such as the colon (large intestine) or rectum. The main goal of surgery for Crohn’s is to remove the diseased portion while saving as much of the bowel as possible.

Types of Surgery for Crohn’s Disease

There are four types of surgical procedures used to treat the symptoms of Crohn’s disease. The type used will depend on the specific complication, the location in the gastrointestinal tract and the severity of the symptoms. These surgical approaches include:

  1. Resection This surgical procedure removes a part of the intestine and is the most commonly performed procedure. After one or more select sections of the intestine are removed, which are usually identified through pre-operative investigations, the remaining healthy sections are put back together. Once the diseased portion(s) are removed it may provide many years of relief from the common symptoms associated with Crohn’s disease. If symptoms do recur, it typically appears at the point where the sections of intestine were joined.
  2. Colectomy If Crohn’s disease affects a significant portion of the colon (large intestine) a colectomy, a partial or complete removal of the colon, may be necessary. After a segmental or partial resectioning of the colon, the colon can often be put back together . If the colon is totally removed, the end of the small intestine can be attached to the rectum.
  3. Proctocolectomy If both the colon and rectum are diseased, it may be necessary to remove both in a procedure called a proctocolectomy. This may be done in one operation, or in stages. The surgery can involve bringing the ends of the small intestine through an incision in the lower abdomen (called a stoma) so that waste can empty from the body into an external bag (pouch).

  4. Strictureplasty In situations where multiple segments of intestine are inflamed or damaged by Crohn’s disease, a special procedure called a strictureplasty can be performed to widen portions of the intestine that have narrowed (or become constricted) due to the buildup of scar tissue over time. This accumulated damage occurs from the repeated process of inflammation and healing. The surgery involves making a cut lengthwise along one side of the intestine where narrowing has occurred and suturing the ends widthwise. This shortens and widens the bowel and eliminates the stricture. Because inflammation from Crohn’s can occur at various places in the bowel, strictureplasty can be performed at multiple places during the same surgery without the need for removing (resectioning) portions of the bowel. This procedure is reserved for patients who may be at risk of having too little bowel, called “short gut,” if a significant portion of affected bowel is removed.

Many of the surgical procedures used to treat Crohn’s disease can be performed using laparoscopic surgery, which means less pain, less risk of infection and a shorter hospital stay. But not all Crohn’s disease patients are candidates for a laparoscopic procedure and a person’s suitability for this minimally invasive option is determined by your doctor on a case-by-case basis.

Considerations before Surgery

Because every patient’s disease pattern is unique, you must form a plan that is designed to meet your individual needs. Before making a final decision, it’s helpful to understand why you may need surgery, to educate yourself about the different surgical options, and to ask questions of your doctor and surgeon. You also may want to speak with patients who have undergone the procedure you are considering. But, while it is important to become educated and exhaust all possible options before pursuing surgery, waiting too long could result in severe complications and/or malnourishment.

Surgery for Crohn’s disease is never a decision that should be taken lightly. All surgery carries some risks. Some risks are common to all surgeries and some are specific to the individual procedures. Ask your surgeon to explain all of the relevant risks associated with the procedure as they pertain to you and your individual condition. Abdominal surgery for Crohn’s disease carries risks related to healing, your incisions and the specific locations where intestines are put back together. Please discuss these in detail with your physicians.

Suggested read: Risk Factors Predicting Severe Crohn’s Disease

Outside of emergency procedures, a decision to perform surgery should be made in collaboration with your doctor and surgeon. It’s important to seek out a surgeon who has significant experience working with Crohn’s disease. And don’t forget to think of yourself as part of your healthcare team. In fact, you are the most important member of your healthcare team and your voice counts as much as anyone’s.

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