Resection is a common surgery for Crohn’s disease that involves removing the diseased part of the small or large intestine and then sewing the healthy ends back together, Dr. Lightner says. Other procedures, such as a strictureplasty (widening a narrow segment of the intestine), can be performed, but for many with Crohn’s disease, resection offers a safe and effective way to get symptom relief.
How Would I Know If I Am a Good Candidate for Crohn’s Disease Surgery?
Crohn’s disease causes inflammation in the bowel, which can lead to strictures (narrowings) or perforations in the intestines. These can lead to infections or fistulas. “Medical treatments are aimed at minimizing inflammation, but they don’t always work,” says James Church, MD, also a colorectal surgeon at the Cleveland Clinic. “Sometimes medical treatments have bad side effects or cannot be tolerated.” In such cases, your doctor may suggest intestinal surgery. The challenge is that Crohn’s disease can occur in multiple areas of the gastrointestinal tract. It also tends to recur. This means some patients with aggressive Crohn’s disease may need multiple resections throughout their lifetime or to go back on medical therapy after a resection to prevent the condition from coming back, Lightner says. Surgeons also need to be careful not to remove too much of the bowel, so the person is able to maintain normal function, according to Lightner. And while there are alternatives to resection for treating strictures, no option exists for treating perforations or fistulas, she says. Even so, Dr. Church says, “The fitter and healthier you are before surgery, the better your recovery should be.” So in the weeks and days prior to surgery, your doctor may ask you to do some of the following.
Pay special attention to healthy eating.Be as physically active as possible.Take antibiotics to treat an infection or prevent a new one.Change a medication dosage.Wear special stockings or take medications to minimize the chance of blood clots. developing in your leg veins, which puts you at risk for a pulmonary embolism.Clean out your gastrointestinal (GI) system the day before surgery. This might involve drinking clear liquids, taking oral solutions, or giving yourself an enema.
What Happens During Resection Surgery?
You’ll probably be admitted to the hospital the morning of your operation and meet with your surgery and anesthesia team. Once anesthesia is administered to put you to sleep, minimally invasive — in most cases — surgery will be performed to remove the diseased portion of the intestine. The portion that’s removed will be checked by pathology. Your surgical team will then decide whether the bowel can and should be reconnected. The surgical connection between the two healthy parts of intestine is called an anastomosis.
What Will Happen After My Surgery?
While most people spend 3 to 6 days in the hospital, full recovery, including returning to work, can take 4 to 12 weeks, according to Lightner. How soon you recover will depend on your condition prior to and after the operation. To ensure proper recovery, your surgeon will provide specific instructions, which may include:
Eating a low-fiber diet for 2 weeksNot lifting anything heavier than 10 pounds for 3 weeks or 20 pounds for 6 weeksNot driving while taking narcotic medicationsAvoiding any activity that causes pain
After a resection, it’s important to keep in mind that your bowels may work differently. “It depends on where the resected area was located and how much was removed,” Church says. “The bowel is good at adapting to new circumstances, but adjustment may take a while.”
What Are the Risks of Resection Surgery?
Every surgery has risks, even for healthy people. Complications such as pneumonia, wound infection, wound hernia, postoperative bowel obstruction, and blood clots in leg veins are all possible. Ultimately, the risks specific to Crohn’s will depend on your overall health. For example, you could:
Become malnourished if your digestive tract can’t process certain nutrientsNeed treatment that involves taking new drugsBecome anemicGet an infection
If you have other health issues, surgery could pose additional risks, such as poor wound healing and other complications. It’s also important to note that a commonly resected area of the GI tract in Crohn’s disease is the last part of the small intestine, called the terminal ileum. This is where vitamin B12 is absorbed and bile salts are resorbed. Removing it could affect how well your body absorbs fats and vitamins, so tell your doctor about any new symptoms you experience after surgery.
How Much Better Will I Feel After Surgery?
Many people with Crohn’s who have resection surgery report an improved quality of life. They can get off most or all medications and may be symptom free for many years. A review published in the January 2019 issue of the journal Gastroenterology Research and Practice found that the majority of people who had the surgery had a positive outlook on their health after the procedure. Crohn’s disease can’t be cured and may require continued treatment. And because Crohn’s can flare up in previously healthy parts of the bowel, it’s possible that you’ll need another surgery in the future. But thanks to ongoing research and clinical trials, there’s hope of finding more effective treatments for Crohn’s disease.
