Resection Surgery for Crohn’s Disease
When medications aren’t working effectively in managing the symptoms of Crohn’s disease (a type of inflammatory bowel disease or IBD), a gastroenterologist may recommend surgery. The most common form of surgery used to treat Crohn’s disease is called a resection. Surgery is not a failure of other therapies but a legitimate type of treatment. Many people with Crohn’s disease will need surgery to manage their IBD or a complication.
During a resection, the portion of the large intestine or the small intestine affected by Crohn’s disease is removed, and the intestine is reattached together using the two healthy ends. Resections are typically done by a colorectal surgeon, a type of surgeon who has special training in surgery done on the lower digestive tract.
In some cases, surgery can put a person with Crohn’s disease into what’s sometimes called surgical remission. This can bring on a period of few or no signs or symptoms of Crohn’s disease. Facing surgery is always difficult, but with Crohn’s disease, a resection can mean a chance to heal and recover. People with Crohn’s disease who have concerns about if surgery either now or in the future should talk with their health care team and consider a second opinion with another colon and rectal surgeon or gastroenterologist.
Why Resection Surgery?
Resection surgery may be used to remove strictures, which could include one long stricture or a group of strictures that are close to one another, or it may be used to remove severely diseased portions of the small or large intestine. The goal of resection is to keep as much of the healthy bowel as possible and to only remove portions of the bowel that are beyond healing. In particular, removing large parts of the small intestine is avoided. The small intestine is where vitamins and minerals are absorbed into the body, and if too much of it is removed, it could lead to nutritional deficiencies. In extreme cases, removing too much small intestine can lead to short bowel syndrome. The overwhelming majority of people don’t need so much surgery that short bowel would be a concern.
How Is a Resection Done?
During a resection, general anesthesia is used to manage pain. The surgery may be done either through open surgery or laparoscopic surgery, but open surgery is far more common. Laparoscopic surgery is typically used only in cases where the diseased section of intestine is located in the ileum, and there are no other complications.
In open surgery, one large incision will be made. The diseased section of the bowel is clamped off and removed. After the diseased portion of the intestine is removed, the two healthy ends of intestine are attached together (called anastomosis).
In laparoscopic surgery, 3 to 4 small incisions are used. The abdomen is filled with gas so the surgeon can better see the abdominal cavity and a camera is inserted through one of the incisions. The rest of the procedure is the same as in open surgery: the diseased bowel is removed and the healthy tissue is reattached.
How Long Is the Recovery Period?
The hospital stay for an open surgery with no complications can be anywhere from 5 to 10 days. For laparoscopic surgery, the hospital stay tends to be shorter.
Recovery from resection surgery can take from 6 to 8 weeks. Returning to work after surgery is a very individual decision, but it generally will be 4 weeks or more after the surgery. A surgeon will give instructions about activity level, but in general, heavy lifting, driving, and other strenuous activities should not be undertaken for at least several weeks after surgery.
What Are the Potential Complications?
Potential complications include those that can occur with any surgery: infection, bleeding, or reaction to the anesthetic. With a resection, there is also a small risk that the two sections of joined intestine may split apart or leak (called dehiscence), though this is not common.
Is Resection Surgery Used for Ulcerative Colitis?
Partial resection of the colon is not typically used to treat ulcerative colitis. This is because the colitis tends to return in the healthy section of the colon that is left. A total colectomy, with the creation of an internal pouch (a j-pouch) or an ileostomy, are the surgeries most often used to treat ulcerative colitis.
In Conclusion,
Most people find their health improves after having a resection for Crohn’s disease. It’s important to follow the surgeon’s instructions and to continue to take medications after surgery to help prevent the Crohn’s from causing more inflammation.
Article Sources
- ADAM Illustrated Health Encyclopedia. “Crohn’s Disease: Inflammatory Bowel Disease.” MedLine Oct 29 2012.
- Crohn’s and Colitis Foundation. “Surgery for Crohn’s Disease.” CrohnsColitisFoundation.org Aug 2010.
- Tilney HS, Constantinides VA, Heriot AG, Nicolaou M, Athanasiou T, Ziprin P, Darzi AW, Tekkis PP. “Comparison of laparoscopic and open ileocecal resection for Crohn’s disease: a metaanalysis.” Surg Endosc. 2006 Jul;20:1036-1044.