Panorama general

Crohn's disease surgery is used to treat symptoms and complications of Crohn's disease. Crohn's disease is a type of inflammatory bowel disease (IBD) that causes swelling and irritation, called inflammation, in the digestive tract.

Over time, inflammation can damage the bowel and lead to strictures, fistulas or abscesses. Strictures are narrowed areas of the bowel. Fistulas are irregular connections between the intestine and another part of the body. Abscesses are pockets of infection.

Surgery does not cure Crohn's disease. Instead, it removes or repairs areas affected by the disease. This can help relieve symptoms and treat complications. The type of surgery depends on where Crohn's disease is found and what problems it is causing.

Types

Some procedures for Crohn's disease remove damaged parts of the digestive tract. Others widen narrowed areas, drain infections or treat fistulas while preserving as much bowel as possible.

Some Crohn's disease surgeries may include an ostomy. An ostomy creates a new way for stool to leave the body through an opening in the abdomen, called a stoma. An ileostomy uses the small intestine to create the opening. A colostomy uses the colon. An ostomy may be temporary or permanent. If it is temporary, it may be reversed later if the bowel can be reconnected.

Types of surgery for Crohn's disease include:

  • Small bowel resection. In this procedure, the surgeon removes a damaged section of the small intestine and usually joins the healthy ends back together.
  • Ileocecal or ileocolic resection. This surgery removes the end of the small intestine, called the ileum, and part of the beginning of the colon. The remaining ends of the intestine are then joined together.
  • Colectomy. This surgery removes part or all of the colon. A partial, or segmental, colectomy removes only the affected section. A total colectomy removes the entire colon.
  • Proctectomy. This surgery removes the rectum. In some cases, the anus also may be removed. A permanent ostomy may be needed.
  • Proctocolectomy. This surgery removes the colon and rectum. An ostomy is created so stool can leave the body.
  • Strictureplasty. This procedure widens a narrowed section of the small intestine, called a stricture, without removing it. Strictureplasty can help preserve the length of the small intestine.
  • Surgery for fistulas or abscesses in the abdomen. When a fistula or abscess develops inside the abdomen, surgery may involve removing the diseased section of bowel. An abdominal abscess may sometimes be drained before surgery.
  • Surgery for fistulas or abscesses near the anus. An abscess near the anus may be drained. If needed, a thin surgical drain, called a seton, may be placed through a fistula. The seton keeps the fistula open so fluid can drain and another abscess is less likely to form. Other procedures may be used depending on the fistula.

Most of these operations can be done using minimally invasive techniques, such as laparoscopic or robotic surgery. Rarely, open surgery may be needed. The surgical approach depends in part on the location and extent of the disease and the operation being performed.

Por qué se hace

Surgery may be considered when Crohn's disease symptoms continue to interfere with daily life despite the best available medical treatment. Because surgery does not cure Crohn's disease, the goal is to relieve symptoms, treat complications and improve quality of life while preserving as much healthy bowel as possible.

Surgery may help when Crohn's disease causes:

  • Stricture or bowel blockage. A narrowed area of the bowel, called a stricture, can cause pain, nausea, vomiting or trouble eating. These symptoms may occur when a narrowed area of the bowel, called a stricture, makes it difficult for food and stool to pass. Surgery may be needed if the narrowing causes a blockage or cannot be treated with medicine or an endoscopic procedure.
  • An abscess or fistula. Pain, fever or swelling may be caused by an abscess, which is a pocket of infection, or a fistula, which is an irregular connection between the bowel and another part of the body. Some abscesses can be drained through the skin, while others may require surgery. Fistulas also may need surgery if they do not improve enough with medicine.
  • Perforation or severe bleeding. Surgery may be needed for a hole or tear in the bowel, called a perforation, or for severe bleeding that does not stop with other treatments.
  • Precancerous changes or colorectal cancer. Surgery may be recommended for certain precancerous changes, called dysplasia, that cannot be completely removed during an endoscopic procedure, or to treat colorectal cancer.

Riesgos

As with any surgery, Crohn's disease surgery can cause complications. The risks depend on the type of surgery, the location and severity of the disease, and a person's overall health.

Possible risks include:

  • Infection at the surgical site or inside the abdomen.
  • A leak where two sections of the intestine are joined, called an anastomotic leak.
  • A pocket of infection inside the abdomen, called an abscess.
  • A temporary bowel obstruction, called ileus, that occurs when the intestines slow or stop moving.
  • The need for another surgery or a return to the hospital.
  • Blood clots in the legs or lungs.
  • Crohn's disease coming back after surgery. Recurrence often develops before symptoms appear, which is why follow-up after surgery is important. Some people eventually need another bowel resection.

The healthcare team takes steps before, during and after surgery to lower the risk of complications. Antibiotics may be given before surgery to help prevent infection, and nutrition support may be used when needed. You also may receive treatment to help prevent blood clots.

Cómo prepararte

Before Crohn's disease surgery, your healthcare team works with you to improve your health and lower the risk of complications. Preparation depends on the type of surgery and whether it is planned or urgent.

Your healthcare team may:

  • Check your nutrition. Poor nutrition can increase the risk of complications after surgery. A dietitian may recommend nutrition support before surgery if you are not getting enough nutrients. When possible, nutrition taken by mouth or through a feeding tube is preferred.
  • Review your medicines. Your healthcare team tells you if you need to stop or change any medicines before surgery. Many biologic medicines used to treat Crohn's disease, including vedolizumab (Entyvio), ustekinumab (Stelara), infliximab (Remicade) and adalimumab (Humira), do not need to be stopped before surgery.
  • Treat an infection or abscess. If you have an abscess in the abdomen, you may need antibiotics and drainage before surgery. This can allow time to improve nutrition and reduce inflammation before a planned operation.
  • Give you instructions to prepare your bowel. For some planned colorectal surgeries, you may be asked to empty your bowel and take antibiotics before the procedure. Follow your healthcare team's instructions about what to eat and drink and how to prepare your bowel.
  • Help you prepare for an ostomy, if one may be needed. An ostomy nurse or another member of the healthcare team can explain what to expect and teach you how to care for the stoma and ostomy pouch.

Follow the instructions from your healthcare team about when to stop eating and drinking before surgery and which medicines to take on the day of the procedure.

Plan for your hospital stay and recovery at home

Arrange for support at home after the surgery since you may feel tired for a few weeks. Plan for time off work, and avoid heavy lifting during early recovery.

Think ahead to what you might like to have with you while you're recovering in the hospital. Things you might pack include:

  • A robe and slippers.
  • Toiletries, such as your toothbrush and toothpaste and, if needed, shaving supplies.
  • Comfortable clothes to wear home. Loose-fitting clothes are ideal after surgery to avoid pressure on the surgical site.
  • Activities to pass the time, such as books, magazines or games.

Qué esperar

Before the procedure

At the hospital, your healthcare team reviews your health and the plan for surgery. You may have an IV placed to give you fluids and medicines. For many bowel surgeries, antibiotics are given shortly before the incision to help prevent infection.

If an ostomy may be needed, the healthcare team may mark the best place for the opening on your abdomen before surgery. You also may meet with an ostomy nurse to review what to expect and learn how to care for an ostomy.

During the procedure

What happens during Crohn's disease surgery depends on where the disease is found and what issues it is causing.

Abdominal surgery may be done through several small incisions using laparoscopic or robotic techniques. Sometimes a larger incision, called open surgery, is needed. When possible, a laparoscopic or robotic approach is generally preferred for abdominal Crohn's disease surgery.

During the operation, the surgeon treats the areas affected by Crohn's disease while preserving as much healthy bowel as possible. Depending on the procedure, the surgeon may widen a narrowed section of bowel or remove a damaged section. If part of the bowel is removed, the remaining ends may be joined together. In some cases, an ostomy may be created instead.

How long surgery takes depends on the type of operation and the surgical approach. Your healthcare team can tell you what to expect for the procedure you are having.

The exact operation may change based on what the surgeon finds during the procedure.

After the procedure

After surgery, the healthcare team monitors you as you recover. Pain medicine is given as needed. You usually are encouraged to get out of bed and begin moving soon after surgery. Early movement is an important part of recovery after colorectal surgery.

Before you leave the hospital, your healthcare team makes sure you can drink and eat enough, manage pain with medicines taken by mouth, and move around safely. Your bowel function also is monitored.

If you have a new ostomy, you receive instructions on how to care for the stoma and ostomy pouch.

Your healthcare team tells you when you can drink and eat after surgery. Most people can start eating within the first day after colorectal surgery.

Resultados

Surgery can relieve symptoms and treat complications of Crohn's disease. Many people feel better after the affected area has been treated or removed. However, Crohn's disease can return in another area or near the place where sections of bowel were joined.

Crohn's disease can return before symptoms develop, so ongoing follow-up is important after surgery. After a bowel resection, your healthcare team may recommend an endoscopy 6 to 12 months after surgery to look for signs that Crohn's disease has returned.

Some people need another operation in the future. Studies of people who have had a bowel resection for Crohn's disease found that about 18% had another resection by five years and about 31% by 10 years.

Diet and nutrition

Your diet may need to change for a time as your digestive tract heals. What you can eat depends on the type of surgery you had and how much intestine was removed. It also depends on whether you have an ostomy. A dietitian can help you choose foods that provide enough calories, protein and nutrients while meeting your individual needs.

If you have an ileostomy, getting enough fluids is especially important because stool bypasses the colon, where water is absorbed. This can increase the risk of dehydration. Your healthcare team teaches you how to recognize and help prevent dehydration.

Some people who have had much of their small intestine removed may have trouble absorbing enough nutrients and fluids. They may need specialized nutrition support and ongoing monitoring by their healthcare team.