Crohn’s Disease Surgery: Types and What to Expect

Surgery for Crohn’s disease involves removing diseased sections of the bowel (resection) and then joining the two ends of your healthy bowel (anastomosis). Even with lifestyle changes and medication, 2 out of 3 people with Crohn’s disease will need surgery. Crohn’s disease is an inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal (GI) tract.

This article discusses when surgery is needed for Crohn’s disease. It also explains the types of surgery, how to prepare for surgery, and what to expect afterward.

There are usually two options for surgery for Crohn’s disease: elective due to a lack of treatment efficacy and emergency due to life threatening complications.

People with Crohn’s disease have an increased risk of developing bowel cancer, which may affect your decision to have surgery.

If medications are no longer effective in managing symptoms, or if you experience complications, you may choose surgery for Crohn’s disease. Surgery is typically the last option, but it may help reduce symptoms.

You may need surgery if you develop severe complications from Crohn’s disease. Examples of such complications include:

• bowel obstruction: partial or complete blockage that prevents the passage of food, liquid, gas, or waste through the bowel
• fissures: tears in the lining of the large intestine, usually near the anus
• fistulas: abnormal openings in the intestines that either allow its contents to leak or unusually connects it to another organ
• abscesses: bacterial infections that lead to a collection of pus
• strictures: narrowing of the small intestine caused by severe inflammation and scar tissue development
• Perforations: holes in the GI tract

Read more about Crohn’s disease.

Surgery is not a cure for Crohn’s disease. However, it can help improve your quality of life by conserving healthy portions of your GI tract.

There has been a relative decline in the need for surgery over the past two decades, except in extreme cases. This may be due to the ability to diagnose the condition earlier and the availability of more effective treatments.

Strictureplasty repairs a stricture or narrowing of the intestine without removing any intestine. Strictures are caused by the buildup of scar tissue due to the repeated process of inflammation, damage, and healing.

It is considered a bowel-sparing procedure. For the procedure, the surgeon makes a lengthwise cut along one side of the bowel, then pushes the two ends together and sutures it widthwise.

Resection is a surgical procedure used to remove part of your small or large intestine damaged by Crohn’s disease. During this procedure, the damaged part of the intestine is removed, and the two healthy sections are joined.

The type of resection used depends on where the damage has occurred.

During this procedure, the end of the small intestine and the beginning of the large intestine are removed. The healthy end of the small intestine is then reattached to the large intestine.

This removes the damaged tissue at the end of the terminal ileum, the small intestine. The terminal ileum is often severely affected by Crohn’s disease.

Segmental colectomy is used when only a small part of the colon or large intestine is affected. A small section of your colon is removed during this procedure. Then the two healthy ends are joined together.

Right hemicolectomy is used when there is a blockage or inflammation in the first part of the colon. During the procedure, the first half of the colon is removed. The appendix and a small part of the small intestine are also typically removed. Then the small bowel is joined with the remaining portion of the colon.

This procedure is often an emergency surgery. This surgery removes most of your colon.

The small intestine is then connected to a hole in your abdominal wall, which is attached to an ileostomy bag. Waste empties into the bag.

This surgery removes the entire colon and joins the last part of the small intestine (terminal ileum) to the rectum. However, this surgery may not be an option if the anal muscles are damaged or if this is scarring or inflammation.

This is a total removal of the colon, rectum, and anus. The small intestine is then brought to a hole in your abdominal wall, where waste drains into a bag.

Crohn’s disease complications are not uncommon.

Fistulas connecting one part of the bowel to another may not require surgery. However, your doctor may recommend this resection surgery if you’re experiencing complications or losing weight.

If you have a large abscess, your doctor may place a small tube through a hole in your skin to drain the pus and fluid from the abscess.

If you have concerns about Crohn’s disease or surgeries, speak with your doctor.

Approximately 31% of people with Crohn’s disease may need a second resection after 10 years. Symptoms of Crohn’s disease may occur again, even after effective surgery.

Factors that can increase the risk of Crohn’s disease reoccurring after surgery include:

• smoking
• fistulas
• abscesses
• having perianal Crohn’s disease, which is Crohn’s disease around your bottom
• having Crohn’s disease in the jejunum area of the small intestine
• having your first surgery for Crohn’s disease at a young age

The risks and complications of surgery will vary. With any surgery, there is a risk of infections and complications with general anesthesia.

Other risks of surgery for Crohn’s disease include:

• anastomotic leak: when two pieces of the bowel are joined improperly and lead to a leak
• bowel obstruction: surgery can increase your risk of scar tissue (adhesions) that can cause blockages

Coexisting medical problems such as high blood pressure and diabetes can increase your risk of complications. Speak with your doctor about the risks and complications of surgery.

Before surgery, your doctor will discuss the risks and benefits. They will also typically advise you on emptying your bowels before the day of surgery.

Your doctor may advise you to avoid smoking before and after surgery, as it can delay healing. You may also need to stop taking some medications before surgery. Your doctor will give you instructions about this.

Discuss with your doctor your plans for care after surgery.

Following surgery, you may need to stay in the hospital for a few days, depending on the type of surgery.

Pain after abdominal surgery is expected, and you will be given pain medications.

Your doctor will likely instruct you to get out of bed and move around soon after surgery to prevent blood clots from forming.

Home recovery will vary. Initially, you may feel weak and tired, so your doctor may want you to avoid strenuous activity for a few weeks.

Also, be aware of symptoms of infection following surgery, such as:

• fever
• redness or discoloration around incision sites
• foul-smelling drainage from the incision

Your doctor may recommend a low fiber diet for ease of digestion. You may need vitamin B injections if your terminal ileum is removed because your body’s ability to absorb this essential nutrient may be affected.

Staying hydrated is also critical because removing your colon can increase the risk of dehydration.

Reasons you may need surgery for Crohn’s disease include bowel obstruction, abscesses, and perforations.

Because Crohn’s disease can be diagnosed earlier and medications have improved, the need for surgery has decreased in the past decades.

Your doctor will discuss the risks and benefits of surgery and answer your questions.