As a rule, doctors don’t like to perform Crohns surgery. Years of illness and poor nutrition have often made many people who are ill with the disease poor surgical candidates. Furthermore, even the most aggressive surgery cannot cure Crohns; it can only solve the problem at hand. For instance, if the surgeon removes part of the small intestine, the other part is still just as vulnerable for episodes of inflammation and infection.
When Crohns disease is diagnosed, the first line of treatment is usually a change in diet to avoid foods that make the symptoms worse. Doctors also caution their patients to stay as active as possible so that their bodies remain strong and resistant to infections. Even if these changes are ineffective, some Crohns patients are able to avoid surgery by taking medications.
According to the Crohns and Colitis Foundation of America, though, in spite of the patient’s and the medical team’s best efforts, the majority of Crohns patients (66 percent to 75 percent) will require surgery for their condition at least once.
What are the reasons for surgery?
Doctors may perform Crohns surgery for a variety of reasons. One of the most common reasons is that the medications simply aren’t working. If the medications don’t help to clear up the painful inflammation and infections, a surgeon must go in to drain any pockets of infection and to resect (remove) the most damaged tissue.
Another reason for surgery is that the patient him or herself requests it. The symptoms of Crohns disease, which can include abdominal pain, an urgent need to defecate, watery or bloody diarrhea, malnutrition, and weakness are very unpleasant, and many patients decide that, even if surgery isn’t a lifelong cure, it will buy them at least a short time of relief.
A third reason that patients living with Crohns disease may require surgery is due to complications from the disease. Complications may include:
• Obstruction or blockage in the small intestine or the bowel
• Heavy bleeding
• A hole or tear in the bowel caused by inflammation
• Fistula
• Abscess, or a pus-filled pocket of infection
Any condition that brings the waste materials in the bowel into contact with the abdominal organs is considered an emergency. If not treated immediately, the waste materials could poison a person’s entire system.
Types of Surgery
A strictureplasty is performed to remove blockages and widen or dilate areas in the bowel that have become narrow due to scarring from the inflammation. A strictureplasty is not a very invasive procedure and can often be done by inserting an endoscope into the rectum and anus while the patient is sedated.
More common surgery for Crohns requires resection or removal of a part of the bowel. If there is a large area of damaged tissue, a surgeon will usually remove the problem area and join the two healthy ends of bowel in a procedure called anastomosis.
Finally, the disease sometimes becomes so severe that most or all of the bowel and rectum must be removed in a procedure called proctocolectomy. The doctor then draws a small healthy stump of the intestine through a hole in the abdominal wall, a procedure called an ileostomy. Wastes will then drain from the stump so that the patient will have to wear a special bag to collect them. This bag is odor-free and easy to cover with clothing, so no one except the patient need know about the ileostomy.
Doctors prefer to avoid Crohns surgery, but if it becomes a necessity, they have several procedures at their disposal to help improve their patient’s condition as much as possible.
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