Surgery

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. 

Surgery for ulcerative colitis

Reasons for surgery

About 20% of patients with UC require surgery. Surgery may be required for any of the following issues:

  • Failed medical therapy

  • Acute fulminant colitis: Severe inflammation resulting in more than 10 stools per day, continuous bleeding, abdominal pain, colonic dilatation on abdominal X-ray film, and severe toxic symptoms including fever and anorexia

  • Toxic megacolon: Expansion of your colon that could lead to rupture

  • Colonic perforation: A hole in the wall of your colon

  • Major hemorrhage 

  • Malignancy (cancer) or prophylaxis (prevention of cancer)

  • Dysplasia: Abnormal tissue developing in your colon, which can be cancerous or noncancerous

Types of surgery and J-pouch

Surgery treatment for ulcerative colitis typically includes a total proctocolectomy (removal of the rectum and part or all of the colon) and ileoanal pouch anastomosis (creation of a J-pouch).

In J-pouch surgeries, after the surgeon does the proctocolectomy (while preserving the sphincter muscle and anus), a pouch shaped like the letter J from the end of the small intestine is created and attached to the rectum.

The J-pouch surgeries are done to avoid needing a permanent stoma (opening) in the abdomen to pass stool through. The surgery done to create the stoma is called an ostomy. There are other similar types of ileal pouches that can be created, called the S-pouch or W-pouch. 

Some patients, such as the elderly, may benefit from having a stoma instead of a J-pouch. An external bag is fitted onto the stoma opening to collect waste.

Other types of surgery conducted in UC include:

  • Colectomy with ileostomy: In this surgery, the surgeon removes the colon but leaves the rectum. A stoma is created and an external bag is fitted to the opening. If you require surgery with a stoma, depending on your situation, you may eventually be able to have a J-pouch created.

  • Colectomy with ileo-rectal anastomosis: In this operation, the colon is removed, but instead of creating an ileostomy, the surgeon joins the end of the small intestine directly to the rectum, thus avoiding the need for a stoma.


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Surgery for Crohn's disease

Reasons for surgery

About 80% of patients with CD will require surgery during their lifetime. Surgery is aimed at treating symptoms and minimizing risk for complications from recurrent disease. Surgery may be required for any of the following issues:

  • Failed medical therapy

  • Recurrent disease

  • Fistula: A deep sore in the intestinal tract that may tunnel into other parts of your intestine or surrounding tissues of your bladder, vagina, or skin

  • Abdominal abscess: Pockets of pus along your intestine caused by infection

  • Stricture: Narrowing of the intestine

  • Malignancy (cancer) or prophylaxis (prevention of cancer)

  • Acute obstruction

  • Peritonitis: Inflammation of the lining of the inner wall of your abdomen

  • Perforation

  • Toxic colitis/megacolon: Expansion of your colon that could lead to rupture

  • Major hemorrhage

Types of surgery

The most common type of surgery in people Crohn's disease is laparoscopic ileo-cecal resection, which is a removal of the cecum (the area that connects the small intestine to the large intestine) and the terminal ileum (the end of the small intestine that connects to the large intestine). This is considered a gold standard treatment. Laparoscopic surgery results in fewer adhesions which is of great benefit if a second surgery is required in CD. 

Other types of surgery conducted in CD include:

  • Stricturoplasty: This improves narrowing and blockages in the small intestine. The surgeon opens up the narrowed part of your intestine and reshapes it.

  • Resection: This is done when a stricture is too long. The surgeon removes the damaged and diseased part of your intestine and sews together the ends of the remaining healthy sections.


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Before, during, and after surgery

Before surgery

Your hospital will give you detailed instructions on how to prepare for surgery. They may involve the following:

  • Going for a pre-admission visit

  • Providing nursing staff with your medical information

  • Receiving verbal and written information about what to expect before, during, and after surgery; if you will require a stoma, you might receive additional information

  • Meeting some members of your healthcare team

  • Having the location of your future stoma site marked on your abdomen, which helps the doctor during surgery

Day of surgery

  • Please arrive at the hospital at the specified date and time requested; leave any jewelry at home

  • The nurse will greet you and have you change into your gown; she will take your vital signs, start an IV, and give you any medication required

  • During your short stay in the operating waiting room, your healthcare team might ask you a few questions

  • They will then transfer you to the operating room and administer anaesthetic

After surgery

  • After surgery, you will be moved to a room where you will be monitored, and where you will eventually wake up

  • You will be transferred to a recovery room where you will stay for a few days

  • Upon discharge from the hospital, you will receive information from the hospital about post-surgical care, medications, and any complications to watch out for

  • Your recovery from surgery will take about four to six weeks; avoid strenuous activity during that time

  • You will require regular follow ups after you go home and you may need a colonoscopy a few months later

  • You may need to adjust your diet and nutrition after surgery.

Additional Resources 

Watch the video below to learn more from an expert gastroentereologist about surgery for IBD and what to expect for recovery:


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Caring for an ostomy

One of the possible outcomes of surgery is an ostomy. An ostomy is surgery to create a stoma (opening) from an end of your intestine inside your body to the outside surface of your abdomen. An external bag is attached to the stoma to collect waste.

Replacing the ostomy bag

Your doctor or ET nurse will tell you how often the bag needs to be replaced. You should replace the bag when it is one-third to one-half full, to avoid having difficulties pulling it off. 

Here are a few steps to follow when replacing your ostomy bag:

  • Prepare the new bag and barrier using the instructions provided with the ba.

  • Remove the bag you are currently wearing. Gently peel away the barrier and lift the bag while pressing down on your skin below it. Try not to irritate your skin. If the bag is sticking to your skin, use an adhesive remover. Drain or dispose of the bag.

  • For a drainable bag, you can open one end and empty it. For a closed bag, you would simply dispose of it and replace with a new one. Putting the pouch in a Ziplock bag will help reduce odour. 

  • Clean your skin and stoma with a wet face cloth or wipe, or clean it in the shower. If you use soap, rinse well. 

  • Let your skin dry and look for irritation. If your skin is irritated, be extra gentle. You can try sprinkling ostomy protective powder on the skin, then blot it off.

  • Measure the size of your stoma if your doctor has requested this.

  • Put the new bag on following the manufacturer’s instructions. Position the opening in the barrier around the stoma. Apply the sticky side to your skin and press it down.

  • If you develop severe abdominal cramping, little or no waste in the bag, or if your stoma becomes pale, dusky or blue, or swells or bleeds, call your doctor.

Irrigating a colostomy

Irrigation is a procedure where you stimulate and flush your intestines at a regular time each day. This helps control when you pass stool.

This should be done under the supervision of your health care team or ET nurse, who will provide you with detailed instructions.

Additional resources

Watch the video below to learn more from an expert about ostomies, pelvic pouches, and how to care for them:
 

 

For more helpful tips and advice about living with an ostomy and support, please visit Ostomy Canada. Crohn's and Colitis Canada is not affiliated with Ostomy Canada. These resources should not be used a replacement to seeking advice from your healthcare providers. 

 


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