Crohn's and Surgery Part 2 - Which are the Most Common Operations?

This series of articles is about the types of surgery that may be needed in the treatment of Crohn’s Disease. You may also find other Crohn’s and Colitis UK information useful, especially our booklets, Crohn’s Disease and Living with IBD. Most of our publications are available from our website: www.crohnsandcolitis.org.uk

Which are the most common operations?

Strictureplasty

The operations most likely to be carried out for Crohn’s Disease are described below:

Strictureplasty
This is a way of treating strictures and blockages in the small intestine which avoids removing any gut.

The surgeon opens up the narrowed section of the intestine with a lengthwise cut, and then reshapes it by sewing it up the opposite way. Food can then pass freely through the reshaped section.

Resection

Resection

If the stricture is long, or there are several strictures close together, a resection may be preferable to a strictureplasty. In a resection the surgeon removes the damaged and diseased part of the gut, and then sews (or staples) together the ends of the remaining healthy sections. This join is called an anastomosis.

Ileo-caecal resection

Ileo-Caecal Resection

It is fairly common for Crohn’s Disease to affect both the terminal ileum (the last part of the small intestine) and the caecum (see the diagram below). If the inflammation is severe and persistent, then it may be necessary to remove that part of the intestine. The healthy end of the small intestine is then joined directly to the large intestine (colon). This operation is known as an ileo-caecal resection (or an ileal caecectomy).

Limited right hemicolectomy
If the first part of the ascending colon (the right side of the colon, on the left in the diagram above ) is also affected, the surgeon may remove this as well, before joining up the rest of the colon. This is a limited right hemicolectomy.

Colectomy with Ileostomy

Colectomy with ileostomy
For those with severe Crohn’s Disease in the large intestine or colon, it may sometimes be necessary to remove most or all of the colon. This operation is called a colectomy.

The surgeon then brings the end of the small intestine out through an opening in the wall of the abdomen. This is an ileostomy or stoma. An external bag is fitted onto the opening to collect the waste. This can be emptied or changed as necessary. (See below for more details on stomas).

Colectomy with Ileo-Rectal anastomosis

Colectomy with ileo-rectal anastomosis
Sometimes when the rectum has remained healthy it may be possible to have a colectomy with ileo-rectal anastomosis. In this the colon is removed but, instead of creating an ileostomy, the surgeon joins the end of the ileum (small intestine) directly to the rectum. This operation is not advisable if the rectum is severely
inflamed or scarred, or if the anal muscles have been damaged. Without a colon the faeces tend to be very liquid and people with this type of anastomosis may need to empty their bowels several times a day.

Proctocolectomy and ileostomy

Proctocolectomy and Ileostomy

If the rectum is also affected by the inflammation it may have to be removed along with the colon and the anal canal, in an operation known as a proctocolectomy.

The surgeon will then create an ileostomy in the same way as for a colectomy.

Surgery for abscesses and fistulas
Abscesses may need to be lanced (opened surgically) and drained. Fistulas linking a diseased part of the small intestine with the colon are usually removed with a resection. Some perianal fistulas can be managed with an operation known as a fistulotomy, in which the fistula is opened and cleaned and left to heal up gradually. Another operation that may help a fistula to heal is the insertion of a Seton Stitch. For more information on these see our information sheet, Living with a Fistula.

Coming up in Part 3 - Laparoscopy, Stomas, Risks and Advantages