Approximately 47% of people with Crohn’s disease and 16% of those with ulcerative colitis will require surgery at some point in their lives. Surgery should not be regarded as a last resort in the treatment of these diseases, nor is it a sign that you or your treatment program have failed. In reality, surgery should be regarded as just another treatment option. Take a tour through our booklet “The Cutting Edge" for more details.
Surgery for Ulcerative Colitis
Removal of the large intestine and rectum (colectomy) may be recommended as a treatment for severe cases of ulcerative colitis. Because the rectum is gone and thus the passage for feces has been removed, your surgeon may have to create an ileostomy (connection of the small bowel to the exterior of your body). An ileostomy uses a bag (otherwise known as an ostomy appliance) attached to the skin of your abdomen to collect expelled feces.
In some cases, surgeons can convert an ileostomy to an ileal pouch anal anastomosis (an IPAA, also sometimes referred to as a pelvic pouch). For those who are eligible for this surgery, the IPAA offers a high degree of satisfaction because a pouch for collecting feces is made inside your body and stool continues to be expelled though the anus rather than into an ostomy bag.
Surgery for Crohn’s disease
Because Crohn’s can involve any part of the GI tract, there are many varied surgical treatments. If you have acquired an abscess, stricture or obstruction, a resection (removal of all or part of a section of the gut) may be required to repair the problem. In some cases, a strictureplasty can be done to open up a narrowed segment of the intestine. As with colitis, a colectomy and ileostomy are possible surgeries. In addition to bowel-specific surgery, patients with Crohn’s can also have surgery to treat problems associated with complications of the disease. For example, if you have developed a fistula, there are procedures available to reduce the pain and pus.
Minimally invasive surgery, or laparoscopic surgery, is performed through small incisions in the abdomen with the aid of special instruments and a camera. Because of the smaller scars, younger people find the prospects of this surgery more appealing than “open surgery.” In addition, healing time is faster and there is less post-operative pain.
Unfortunately, not all people with Crohn’s or colitis are candidates for laparoscopic surgery, usually because of extensive scarring within the abdomen or because the disease is so extensive that a wider field of view is needed than that offered by the scope.