Crohn’s disease cannot be cured with surgery. The illness often recurs at the suture line or moves to a new are, and surgical treatment must aim at saving as much of the intestine as possible. The reason for surgery is usually a stricture, an obstruction, an abscess or severe inflammation that does not respond to medication. Severe bleeding, perforation of the bowel or fistulas can also lead to surgery, as well as continuous anemia, pain, malnutrition or anaplasia (cancer risk).
About a quarter of Crohn’s disease patients are operated within the first five years and half within 20 years. About a half of those who have been operated will have to be operated again. It is always better that the surgery is pre-planned, and a good general condition and nutritional state promote recovery. It is recommended that the patient quits smoking before surgery, and alcohol should be consumed within limits.
As much of small intestine as possible should be saved, because it is an important factor in the absorption of nutrients. Usually, only the part of the bowel with ailments is removed. The large intestine has an important role in maintaining fluid balance and it is not removed entirely if a part of it is healthy. Sometimes a temporary ostomy is necessary to settle the inflammation. In case of severe rectal Crohn’s disease, the entire rectum may have to be removed and the patient will need a permanent ostomy.
The biggest risk for those who had surgery is that the suture line fails, there is an obstruction or the wound gets infected. Continuation of medication is decided individually. It is good to have a colonoscopy within a year to check the suture line as the illness often recurs there.
Having a surgery is often postponed because the patient is afraid of it and the possibility of an ostomy. Most patients think later, however, that they should have had surgery much earlier.