When medicine and lifestyle changes fail to help a Crohn’s sufferer find relief, surgery is often the next step. This surgery, called a colectomy, is an outcome for many Crohn’s patients. The Crohn’s & Colitis Foundation of America reports that two-thirds to three-fourths of all Crohn’s patients eventually will require surgery.
Crohn’s disease occurs when the body’s immune system begins attacking its own tissues, causing inflammation in the intestinal tract. This creates a variety of uncomfortable and even painful symptoms, including frequent diarrhea, abdominal pain, and even infection. While there’s no known cure for Crohn’s, many sufferers eventually go into remission for many years, usually either through medicine or surgery.
Several surgeries of varying complexity may be performed for Crohn’s patients, and colectomies are among the most intrusive. In a colectomy, the colon is re-sectioned to varying degrees. If possible, the ileum and rectum are joined, to allow the patient to continue to pass waste without having to wear an external bag.
How Colectomies Work
Colectomies are performed for Crohn’s, colon cancer, diverticulitis, and other conditions. The procedure was traditionally performed by making an incision in the abdomen to remove the colon. Recently, however, the surgery has begun being performed via laparoscopy, which requires smaller incisions, minimizes healing time, and reduces risk of complications.
Colon re-sectioning involves removing a part of the colon and reattaching the remaining sections to restore bowel function. If you’re considering undergoing a colectomy, you may have to choose between a colostomy (a surgery in which your large intestine is brought through the abdomen and empties into a bag) or an anastomosis (a binding of two sections of the intestine to retain bowel function). There are downfalls to both of these that can make the decision very difficult.
An anastomosis carries with it some risks, primarily a breakdown of sutures which can cause infection and lead to sepsis. In rare cases, it can be fatal. Although safer, a colostomy carries its own risks. A colostomy creates an exit for feces which must be manually emptied out. Certain colectomy patients may be eligible for a colostomy with irrigation, which creates a cap over the stoma (exit), keeping waste inside. The patient must irrigate it at least once a day, using an irrigation sleeve.
The traditional colostomy patient has a pouch attached, which must be emptied or changed at various intervals throughout the day. Today’s colostomy pouches are much more odor-free and sterile than previous generations, allowing patients to live a normal life without concern about others knowing about their condition. Many physicians will instead opt for a colo-anal pouch, called the ileo-anal pouch, which is constructed using the patient’s lower intestine.
Post-surgery Crohn’s patients often must maintain a low-fiber diet at first to reduce stress on the digestive system. While some patients have a mostly symptom-free life following surgery, 50 percent of all patients experience Crohn’s symptoms within three to four years following re-sectioning.
Infliximab may be prescribed by some physicians for patients to avoid recurrence of symptoms.
Infliximab, sold under the brand name Remicade, is a TNF blocker that works to prevent the body’s immune system from malfunctioning. Studies have shown success at preventing recurrence among patients who take Remicade following re-sectioning.
When problems recur post-surgery, it’s usually in a different area of the intestines, requiring additional surgeries.
Why Get a Colectomy?
With such a high rate of recurrence, some may wonder: why get a colectomy at all? For many Crohn’s sufferers who undergo colectomies, there isn’t a choice. The patient’s symptoms may be so severe that medication doesn’t help. Or, the patient may be experiencing perforations or fistulas that require immediate attention. For others, the decision to have a colectomy is made following long, careful deliberation.
While removal of all or part of the colon can certainly help short-term symptoms, surgery doesn’t cure Crohn’s disease. There is no cure for Crohn’s at this time, only the possibility of lessening symptoms. For some patients, Crohn’s medications will become a way of life. For others, a colectomy may induce long-term remission, although a recurrence is always possible. If a colectomy offers even the smallest amount of relief after years of painful symptoms, it may be worth it to some patients.