When medicine and lifestyle changes fail to help people with Crohn’s disease find relief, surgery is often the next step. The Crohn’s & Colitis Foundation of America (CCFA) reports that two-thirds to three-fourths of all people with Crohn’s disease will eventually need surgery.
Crohn’s disease occurs when your body’s immune system begins attacking its own tissues, causing inflammation of the intestinal tract. This creates a variety of uncomfortable and painful symptoms, including frequent diarrhea, abdominal pain, and even infection. While there’s no known cure for Crohn’s disease, many people eventually go into remission for many years, usually either through medicine or a surgery called a colectomy.
Several surgeries are available for people who have Crohn’s disease, and colectomies are among the most intrusive. During a colectomy, the colon is re-sectioned to varying degrees. If possible, your surgeon will join the ileum and rectum to allow you to continue to pass waste without having to wear an external bag.
How Colectomies Work
Colectomies are performed for people who have Crohn’s disease, colon cancer, diverticulitis, and other conditions. Originally, the procedure was performed by making an incision in the abdomen to remove the colon. The surgery is now often performed using laparoscopy and using many smaller incisions. This minimizes healing time and reduces the risk of complications.
Colon re-sectioning involves removing part of your colon and reattaching the remaining sections to restore bowel function. Usually, a partial colectomy, which involves removing the affected part of the colon, is performed. If you’re considering a colectomy, you may have to choose between an anastomosis, which is a binding of two sections of your intestine to retain bowel function, and a colostomy, which is a surgery in which your large intestine is brought through your abdomen to empty into a bag. There are pros and cons to both, which can make the decision very difficult.
Anastomosis and Colostomy
An anastomosis carries some risks. Primarily, there’s a risk of the breakdown of sutures, which can cause infection and lead to sepsis. It can also be fatal in rare cases. Although a colostomy is safer, it carries its own risks. A colostomy creates an exit for feces that must be manually emptied out. Certain people who have a colectomy may be eligible for a colostomy with irrigation, which creates a cap over the stoma, or exit, keeping waste inside. They must irrigate it at least once a day, using an irrigation sleeve.
If you have a traditional colostomy, you’ll have a pouch attached. This must be emptied or changed at various intervals throughout the day. Today’s colostomy pouches have fewer odors and are more sterile than previous ones, allowing you to live a normal life without concern for others knowing about your condition. Many doctors will instead suggest a colo-anal pouch, called the ileoanal pouch, which is constructed using your lower intestine.
After surgery, you must initially maintain a low-fiber diet to reduce stress on your digestive system. According to the CCFA, about 20 percent of patients show a recurrence of symptoms after two years, 30 percent show a recurrence of symptoms after three years, and up to 80 percent show a recurrence of symptoms by 20 years. Not all recurrences mean that you’ll need another operation.
Infliximab (Remicade) may be prescribed to avoid a recurrence of symptoms. Infliximab is a tumor necrosis factor (TNF) blocker that works to prevent the body’s immune system from malfunctioning. It has proven successful.
When problems recur after surgery, it’s usually in a different area of the intestines. This may require additional surgeries.
Why Get a Colectomy?
With such a high rate of recurrence, you may wonder why you should get a colectomy at all. For many people with Crohn’s disease who undergo colectomies, their symptoms may be so severe that medication doesn’t help or they may have perforations or fistulas that require immediate attention. For other people, the decision to have a colectomy is made after a long period of thinking carefully about it.
While removal of all or part of your colon can certainly help your short-term symptoms, surgery doesn’t cure Crohn’s disease. There’s no cure for Crohn’s disease at this time. There’s only the possibility of lessening and managing symptoms. For some people, Crohn’s disease medications will become a way of life. For others, a colectomy may lead to 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 for some people.