Unfortunately, surgery is necessary in approximately 75% of people with Crohn’s Disease. This may be done for a variety of reasons, including excessive bleeding, perforation of the bowel, intestinal obstruction, formation of an abscess, or when other medical treatments fail. However, surgery is almost always used as a last resort and is typically avoided if possible. For this reason, many people suffer for years with symptoms that could be relieved if surgery were utilized.
There are various options available, including procedures to remove affected areas of the intestine as well as procedures to redirect stool to an opening where it is passed out of the body. However, the latter requires life changes that are difficult for some to deal with.
Strictureplasty is the most common surgical procedure performed for Crohn’s Disease. This is a procedure in which a narrowed area of the intestine is widened. Patchy, diseased areas narrow and are known as strictures. Because these areas of diseased bowel alternate with portions of normal bowel, cramps occur as the normal bowel tries to compensate for blockages that arise. It is not suggested to remove large segments of bowel as nutritional deficiencies may occur. Therefore, strictureplasty is performed to avoid removing any of the intestinal tract but still improve conditions.
However, removing diseased sections of intestine is sometimes necessary and is known as resection. There are various forms of resection, depending on which area of the bowel is being removed. However, after any portion is taken out, the two ends of healthy bowel are reconnected to restore intestinal function. This is known as anastomosis.
Other surgical procedures include the treatment of abscesses and fistulas. This may include draining pus or repairing damaged areas. These areas are of particular concern as they may lead to severe infection, leading to death if not properly treated. Special care must be taken in removing abscesses from the rectal area, as damage to those muscles may lead to incontinence.
It is necessary to understand that there is no cure for Crohn’s Disease; therefore, surgery may only temporarily relieve symptoms. Negative side effects usually return with time, often at the same location of the surgery. Almost half of those that need surgery will also require a second procedure.
Research is being done to determine if microinvasive or laparoscopic surgery may be utilized to decrease the intrusive nature of surgical procedures. While this may greatly improve the process, it is still being explored.