Surgery for Crohn’s Disease

Types of Surgery for Crohn’s Disease

Crohn’s disease can affect the entire gastrointestinal tract, and there are different surgeries to treat each area.

Each procedure is tailored to the “extent and behavior of the patient’s disease,” says David Row, MD, the chief of colorectal surgery at Loma Linda University Hospital in California.

“When talking about extent, Crohn’s can involve the small intestine only, both the small and large intestine, and only the large intestine,” he says. “Crohn’s can also behave as inflammatory only, stricturing (causing narrowing of the intestine), or fistulizing (creating abnormal connections with other portions of the intestine) disease.”

Below are the different types of surgery for Crohn’s disease and what they entail.

Bowel Resection

A bowel resection is a procedure in which a surgeon removes the diseased part of the small or large intestine and stitches the healthy portions together.

This type of surgery may be recommended to treat strictures, or the narrowing of the intestines caused by scarring from inflammation. If left untreated, this scarring can lead to blockages that prevent waste from moving through the intestines.

Bowel resection is the most common type of surgery for Crohn’s disease, according to research published in November 2022 in Gastroenterology Report.

Stricturoplasty

A stricturoplasty is another type of procedure to treat strictures. It involves widening the narrowed part of the intestine without removing any part of the organ.

Proctocolectomy and Colectomy

If the large intestine — made up of the colon and rectum — becomes extensively diseased from Crohn’s, all or part of it may need to be removed. In a proctocolectomy, the colon and rectum are removed, while in a colectomy, only the colon is removed.

With a proctocolectomy, surgeons invert the end of the small intestine through a small opening in the abdomen (called a stoma) through which waste can flow into an ostomy bag.

For individuals who undergo a colectomy, the lower part of the small intestine is surgically connected to the rectum, allowing waste to pass through the anus normally.

Fistula Removal

A fistula is an abnormal connection between the intestines and another organ, such as the skin around the anus. Fistulas occur as the result of sores or ulcers that develop on the intestinal wall because of inflammation from Crohn’s. Fistulas may lead to open skin abscesses that drain liquid, pus, or stool.

Fistulas that don’t heal with medications will need surgery to drain and close them.

How Do I Know if I’m a Candidate for Crohn’s Surgery?

Surgery for Crohn’s is typically reserved for individuals who have failed to respond to the available medications to treat the disease.

“The medical therapeutic options include first-line agents such as anti-inflammatory medications, second line agents such as immunomodulators, and third line agents such as biologics,” Dr. Row says. “When these medicines fail to control a patient’s disease symptoms they are often deemed to be ‘medically refractory’ and require surgery.”

The decision to move forward with surgery requires a consensus agreement between the patient, their treating gastroenterologist, and their colorectal surgeon, he notes.

Additionally, individuals with Crohn’s are often advised to undergo surveillance colonoscopy with biopsies to closely monitor their disease and to tailor medical therapy. “Should any biopsies show precancerous or cancerous changes, this would be another point when surgery is recommended,” Row says.

Finally, surgery may be required if a person with Crohn’s becomes so ill that they are hospitalized and deemed “toxic” from severe, uncontrolled disease.

“In this situation, surgery is performed under emergency circumstances as a lifesaving measure,” Row says.

Will Surgery Cure Crohn’s?

It’s important to remember that there is no cure for Crohn’s disease and that the goal of surgery is to manage its symptoms. Continuous treatment with medication is often needed to control the disease.

“Surgery often ‘resets’ the clock so that an individual can resume or start receiving the effective medicines that are currently available after the majority of their disease ‘burden’ has been removed,” Row says.

That said, for most Crohn’s patients, quality of life is greatly improved after surgery.

“Most patients do well after surgery and resume their usual activities and diet,” Dr. Henry says. “If a patient was not able to eat enough to stay well-nourished before surgery, we work with a dietitian to help them regain weight.”

A research review published in the January 2019 issue of the journal Gastroenterology Research and Practice found that the majority of people who undergo bowel resection surgery have a positive outlook on their health after the procedure.

Since Crohn’s disease can flare up in previously healthy parts of the gastrointestinal tract, some people require multiple surgeries throughout their lifetime. But ongoing research and clinical trials offer hope for more effective treatments for Crohn’s disease.