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Crohn's Disease

Surgery For Crohn's Disease

Wednesday, March 21, 2012 - 13:34

Contributing Author: Guy Slowik FRCS

Surgery does not cure Crohn's disease, but corrects an immediate problem that cannot be resolved using medication. Four types of surgery are commonly performed on individuals with Crohn's disease:

It is estimated that about 75% of individuals who live with Crohn's disease will require surgery at some point in their lives, and that 75% of those who have one surgery will need at least one subsequent surgery.

Partial Bowel Resection

Resection is usually performed when a portion of intestine has been so damaged by disease that a permanent partial obstruction has formed. The most common areas removed are the terminal ileum, the ileocecal valve, and a small portion of the large intestine.

Usually, the surgeon will attach (anastomose) the healthy ends of intestine together during the procedure. Sometimes, however, there is mild inflammation throughout the intestine, preventing such reattachment. In these cases, a temporary ostomy is created. The ostomy allows intestinal contents to drain directly out of the body into a collecting bag through the abdominal wall. The ostomy is usually closed and the bowel reattached six to eight weeks after the initial surgery.

After surgery, disease tends to occur above the surgical point, closer to the stomach. Successive resections are sometimes necessary. Statistically, the longer the period of time between diagnosis and first surgery, the longer the period between first and second surgery (if necessary), second and third surgery (if necessary), and so on. Research shows that some of the new 5-ASA compounds are helpful in delaying the recurrence of symptoms after surgery.

Strictureplasty

Strictureplasty is a procedure that opens up small strictures. An incision is made down the length of stricture. The incision is pulled together and sewn across the stricture, shortening the intestine slightly but widening the formerly narrowed area.

Correcting Fistulas

Fistulas that connect the intestine to another internal organ, such as the bladder, must be surgically closed in order to keep intestinal contents from draining into the organ and causing infection.

Draining Abscesses

When an abscess does not respond to medical treatment, it must be drained to promote healing. Needle aspiration is the most common method. A hollow needle is inserted through the skin and into the abscess, then used to withdraw the infectious material. In another method, a surgeon exposes the abscess surgically, removes the infectious material, and places a wick to promote drainage and healing from the inside.

Crohn's Disease