Crohn's Disease - Surgery

Surgery is rarely done for Crohn's disease and it is not a cure. When surgery is needed, as little of the intestines as possible is removed to preserve normal function. The disease tends to return in areas that were previously not affected, and you may need surgery again.

Surgery may be needed for Crohn's disease if no medicine can control your symptoms, you have serious side effects from medicines, your symptoms can be controlled only with long-term use of corticosteroids, or you develop complications such as fistulas, abscesses, or bowel obstructions.

Surgery may be needed when you have:

• Bowel blockage (obstruction).
• Abscesses or tears (fissures) in the anal area or when abnormal connections (fistulas) form between two parts of the intestine or between the intestine and other internal organs.
• Holes (perforations) in the large intestine.
• Cancer or precancerous tissue.
• Severe disease that does not respond to other treatment.
• Severe bleeding that requires ongoing blood transfusions.

Surgery Choices

Surgery is not usually done for Crohn's disease. If you do have surgery, it will most likely be one of the following:

• Resection: The diseased portion of the intestines is removed, and the healthy ends of the intestine are reattached. Resection surgery does not cure Crohn's disease, which often comes back near the site of surgery.
• Proctocolectomy and ileostomy: The surgeon removes the large intestine and rectum, leaving the lower end of the small intestine (the ileum). The anus is sewn closed, and a small opening called a stoma is made in the skin of the lower abdomen. The ileum is connected to the stoma, creating an opening to the outside of the body, where stool empties into a small plastic pouch called an ostomy bag that is applied to the skin around the stoma.
• Strictureplasty: The surgeon makes a lengthwise cut in the intestine and then sews the opening together in the opposite direction. This makes the intestine wider and helps with obstruction of the bowels. This is sometimes done at the same time as resection, or when a person has had resection in the past. Strictureplasty is used when the doctor is trying to save as much of the intestines as possible.

Another procedure that may be done is balloon dilation. This is not a surgery. The doctor runs an endoscope through your intestines from your anus. The endoscope is a long, thin tube that has a video camera on the end. Next, the doctor uses the endoscope to thread an uninflated balloon across the stricture (the narrowed part of the intestine). When the balloon is inflated, it makes that part of the intestine wider. The balloon is deflated and then removed. Balloon dilation is a new technique and not as much is known about its long-term success compared to the surgical procedures listed above. Balloon dilation might be done if you want to put off a more complicated surgery for a while or if you have had surgery before and the doctor wants to save as much of the intestines as possible.

What To Think About

These surgeries can be done on children. Surgery can improve a child's well-being and quality of life and restore normal growth and sexual development.

In rare cases, intestinal transplant is used to treat Crohn's disease. In this complex procedure, the small intestine is removed and replaced with the small intestine of a person who has recently died and donated his or her organs.

In very rare cases, when the risk of other surgery is high, bypass surgery may be done to preserve the bowel. In this procedure, the intestine is cut above the diseased area and reconnected to a healthy section below the diseased area. The diseased part of the intestine remains but is no longer used. This surgery is not done often because the diseased loop remains and may cause problems later.

WebMD Medical Reference from Healthwise

Via: http://www.webmd.com

Ileostomy, Colostomy, and Ileoanal Reservoir Surgery

Sometimes treatment for Crohn's disease, ulcerative colitis, and familial adenomatous polyposis involves removing all or part of the intestines. When the intestines are removed, the body needs a new way for stool to leave the body, so the surgeon creates an opening in the abdomen for stool to pass through. The surgery to create the new opening is called ostomy. The opening is called a stoma.

Different types of ostomy are performed depending on how much and what part of the intestines are removed. The surgeries are called ileostomy and colostomy. When the colon and rectum are removed, the surgeon performs an ileostomy to attach the bottom of the small intestine (ileum) to the stoma. When the rectum is removed, the surgeon performs a colostomy to attach the colon to the stoma. A temporary colostomy may be performed when part of the colon has been removed and the rest of it needs to heal.

Ileoanal reservoir surgery is an alternative to a permanent ileostomy. It is usually completed in two surgeries. In the first surgery, the colon and rectum are removed and a pouch or reservoir is constructed from the last 18 inches of the small intestine. This pouch is attached to the anus. In the second surgery, the ileostomy is closed. The muscles surrounding the anus and anal canal are left in place, so the stool in the pouch does not leak out of the anus. People who have this surgery are able to control their bowel movements.

If an ileoanal reservoir is not possible or feasible, a continent ileostomy may be an alternative to using an outside collecting bag. In continent ileostomy, an internal reservoir pouch is created from part of the small intestine. A valve is constructed and a stoma is placed through the abdominal wall. A tube is inserted through the stoma and valve to drain the pouch.