Crohn's Disease Surgery - Laparoscopic Surgery

Since approximately 1990, laparoscopic surgery has been used for many different types of gastrointestinal disorders, such as gall bladder disease and appendicitis. This type of surgery, sometimes referred to as "minimal access surgery" or "keyhole surgery," involves using instruments that are passed through several (usually three or four) small incisions on the abdomen. One of the instruments is a camera that allows the surgeon to see inside the abdomen without opening it up with a large incision. The other instruments act as the "hands" of the surgeon, used for cutting, suturing, stapling and all of the other things that a surgeon would normally do during a standard open-approach operation.

 

When a piece of an organ, such as the intestine, is removed, the incision at the belly button is usually extended a few centimeters in order to allow the intestine to be brought out. The advantage of the laparoscopic approach is that it leaves very small scars on the abdomen. These are often not noticeable unless one closely examines the area. In addition, it appears to reduce, to some extent, but does not eliminate, the pain after surgery and allows faster discharge from hospital. For some operations, such as gall bladder, it allows quicker recovery and return to work or school.

 

 

Even though a laparoscopic approach is planned when an operation is started, it is not always possible to complete the entire operation this way because there may be many adhesions (scars) within the abdomen from previous surgery that make it impossible to see well enough using the laparoscopic camera. In other cases, the Crohn's disease is too complex, with many internal fistulas from one segment of intestine to another or an abscess associated with an inflamed segment of intestine. Using a laparoscopic approach in this case would be unsafe. When surgeons encounter these limitations and complications, they will convert to an open approach.

 

Although laparoscopic surgery results in major reductions in pain, hospital stay, and recovery time in some disorders, these benefits over the open approach in the average case of IBD are not as obvious. There is still post-operative pain requiring medication, a hospital stay that averages about 5 days if no complications occur, and 3 to 6 weeks before someone is ready to return to work, school, and other daily activities.

 

If you have had multiple operations and if a large part of your intestine has been taken out, you may ultimately not be able to adequately absorb nutrients, water, minerals, and electrolytes from your diet. This can be a very serious problem — more serious than the Crohn's disease itself. At the end of the day, the real challenge in the field of surgery for Crohn's disease is not so much how to perform an operation, but how to prevent the disease from coming back after the diseased bowel has been removed.

 

However, it appears that some individuals are at lower risk of recurrent Crohn's disease and may not need treatment after surgery. Unfortunately, there is no good way to predict who is at high risk and who is at relatively low risk.