Will I need surgery for Crohn's disease?

The type of surgery done for Crohn's disease depends on how Crohn's has affected the intestines. Often, small portions of the small or large intestine have to be removed. Rarely, an entire organ is severely affected and must be removed. Sometimes the intestines are connected to the skin through an ileostomy, and an ostomy bag is used to collect stool. Surgery is often required to treat complications of Crohn's disease, such as an obstruction, perforation or fistula.

Surgery should be looked at as a therapeutic option rather than as a failure of therapy. Indeed, the goal of surgery is to improve quality of life and help patients lead healthier, more active lifestyles. For example, if only a short segment of your small intestine is affected by Crohn's disease, you may benefit from surgery without the exposure to potentially harmful side effects of medications. Although the use of medications such as biologics or immunomodulators can be indispensable for many patients, their prolonged use in the setting of a poor response may delay surgery, and as a result, may increase the risk for complications.

As a general rule, most surgeons aim to preserve as much of the bowel as possible (using bowel sparing surgery) when surgery is needed. Typically, for isolated disease that affects only a small area of the intestine, the initial operation used is called a resection. The surgeon will cut above and below the diseased area, remove a section of the intestine and reconnect the two areas. This allows for the relief of symptoms such as bloating, nausea, pain and vomiting.

Short areas of stricturing can be treated with a procedure called a strictureplasty. A strictureplasty does not remove the diseased segment of the bowel, but opens the narrowing in a way that restores flow of intestinal contents and allows nutrients to be absorbed. Sometimes, it is necessary to undergo multiple strictureplasties in a single operation if several areas of the small intestine are diseased.

When stricturing is more extensive (over a greater area) and patients have threatened short bowel syndrome, a side-to-side isoperistaltic strictureplasty may be needed. This technique was developed by Dr. Fabrizio Michelassi, the surgeon-in-chief at NewYork-Presbyterian/Weill Cornell, and alleviates symptoms while preserving as much intestine as possible.

Crohn's disease is mostly managed medically. Surgery for Crohn's disease is reserved for emergent situations such as intestinal obstruction, uncontrollable bleeding, or intestinal perforation. The surgical treatment should be as conservative as possible in order to preserve as much healthy intestine as possible.

As current medicines have improved in the treatment of Crohn's Disease fewer people are requiring surgery. Learn more from Dr. Eugene Yen on behalf of NorthShore University HealthSystem about treating Crohn's Disease.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.