Surgical Procedures for Crohn's Disease

Unlike ulcerative colitis, Crohn's disease can affect any part of the gastrointestinal tract and can recur in previously unaffected segments of intestine following surgical resection of a diseased area. Although there are theoretically many different types of operations that can be performed for Crohn's disease, in practice a handful of operations account for the majority actually performed, chiefly small intestine and large intestine resections and perianal procedures.

 

 

The most common operation performed for Crohn's disease is a small intestinal resection. This is usually performed because an area of small intestine is affected by Crohn's disease, and this has led to scarring and narrowing of the intestinal opening through which food passes. This produces symptoms of pain, bloating, nausea, and vomiting after meals and can even lead to bowel obstruction. Small intestinal resections may also be required when a fistula or an abscess has arisen from an affected segment of intestine or when symptoms of active inflammation in the small intestine (abdominal cramping, diarrhea, weight loss) do not respond to drug therapies.

 

Ileocecal Resection: When the large intestine has no obvious Crohn's disease, only the very first part of the colon, called the cecum, is resected. This is called an ileocecal resection: the last part of the ileum and the first part of the colon are taken out together as a single piece of intestine.

 

Ileocolic Resection: If part of the large intestine is affected by Crohn's disease — most commonly on the right side in an area involving the cecum and part of the ascending colon — then it is often resected along with the terminal ileum. This operation is called an ileocolic resection.

 

Small Intestinal Resection: When there is a normal segment of small intestine between the lowermost extent of the affected small intestine and the ileocecal valve, it is technically possible to remove only the affected segment of small intestine and not remove any of the large intestine. This is called a small intestinal resection.

 

Anastomosis: In all of these operations, the removal of a segment of intestine leaves two unattached or open ends of small intestine or one open end of small intestine and one of large intestine. These ends are sewn or stapled together to re-establish the continuous flow of intestinal contents all the way through the gastrointestinal tract.

 

However, in some situations the surgeon may decide to create a temporary stoma above the surgical hookup site (anastomosis) in order to divert the intestinal contents away from the anastomosis so that it has the best chance of healing fully. This is usually done when there has been an abscess or uncontrolled infection in the area of the anastomosis prior to surgery and the risk of poor healing is higher. In most cases, the stoma is closed during another surgical procedure several months later.