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Crohn's Surgery Options

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Even with proper medication and diet, people with Crohn's disease or ulcerative colitis may require or opt for surgery at some point during their lives. While not a cure, surgery has the potential to dramatically improve quality of life.
The most comon surgeries are listed below. Click the name to learn how these procedures work and what these procedures look like within your body.

Strictureplasty
A stricture may occur when inflammation from your disease causes the wall of the intestine to thicken, causing a narrowing in that section of the intestine. Strictures are important to treat because the narrowing could lead to a blockage that does not permit stool to pass through the body. Strictures may be treated in a surgical procedure known as a strictureplasty, where the narrowed area of the intestine is widened without removing any portion of the intestine. The surgeon makes cuts lengthwise along the narrowed area and then sews it up crosswise.
This shortens and widens that part of your intestine, allowing the food to pass through.

Small intestine (bowel) resection
A procedure where a portion of the small intestine is removed, and the two healthy ends are joined together.
The amount of small intestine that is removed depends on how much of the intestine is damaged by inflammation from the disease. This is usually performed in patients with longer segments of disease. It may also be performed to treat strictures if a patient is not a good candidate for a strictureplasty.

Ileocecal resection
The last part of the small intestine (terminal ileum) is often severely diseased from Crohn’s. If this area has a stricture, fistula, or an abscess, it often requires removal in a procedure known as an ileocecal resection. During this surgery, the last part of the small intestine and the very first part of the colon (cecum) are removed and the healthy small intestine is sewn to the colon.
The appendix may also be removed because it is attached to the cecum.

Large bowel resection
A procedure where a portion of the large intestine is removed, and the two healthy ends are joined together.

Proctocolectomy
A surgical procedure in which both the colon and rectum are both removed. This can be done in two ways:
A proctocolectomy with an end ileostomy:
Once your colon and rectum are removed, your body still needs a place to expel waste. In order to do that, your surgeon will invert a piece of your small intestine. He will then make a small hole (stoma) in your abdominal wall and place the inverted tip through, so that any waste can be released outside of your body. This is process is called an ileostomy. An ostomy pouch is attached to the abdomen around the stoma to collect any waste. The surgeon will typically do this in one procedure. This procedure is less common in recent years, and many patients attempt to have a pouch constructed and have the ostomy reversed.
A proctocolectomy with ileal pouch-anal anastomosis (IPAA)
This procedure also involves the removal of your colon and rectum, but rather than having an ostomy pouch attached to your abdomen, the end goal of this surgery is to help you continue to have bowel movements through your anus. Since the colon and rectum are removed, the small intestine needs to be attached to your anus. This can either be done with a straight join, or with an internal pouch created from the small intestine. This internal pouch would replace your rectum, where waste is stored before being expelled. The pouch is commonly shaped like a “J” so it is often called a j-pouch. Because this can be a complex surgery, it is sometimes broken up into one, two, or three stages, or operations.
One stage procedure means that the surgeon completes all of the steps above in one operation
Two stage procedure means that the surgeon will perform two operations:
First operation will be to remove your colon and rectum, create the internal pouch, and attach it to the anus. Then the surgeon will create a temporary hole (stoma) in your abdomen where a small piece of your intestine is inverted through it, known as a diverting loop ileostomy. Waste will be expelled into an external ostomy pouch temporarily while your intestines heal.
In the second operation, the surgeon will reverse the inverted piece of your small intestine so that waste can now move through the new internal pouch and anus.
Three stage procedure means that the surgeon will perform three operations:
During the first surgery, the colon is removed and a temporary end ileostomy (using end of the small intestine) is created. The rectum is left behind after this procedure.
In the second surgery, the rectum is removed and an internal pouch made from the end of the small intestine. The temporary end ileostomy is reversed and a temporary diverting loop ileostomy is created.
The third surgery reverses the ileostomy and restores normal bowel function through the internal pouch.

Colectomy
A colectomy is the removal of your entire colon or large intestine, without removing the rectum.
Once the colon is taken out, the end of the small intestine can be joined to the rectum. This allows the person to continue to pass stool through the anus. This surgery can be done in one step, or it may need to be done in a few stages depending on the disease.

Abscess drainage
An abscess is a collection of pus that can form in the body. Some common symptoms of an abscess might include fever, pain, or you may have discharge. In order to treat an abscess, your doctor will use both antibiotics and surgery to drain the pus to allow for proper healing. The surgeon will locate the abscess, make a small cut, and insert a thin tube to drain it. Some people may have this tube for a week or more. Most people feel better within a few days.

Fistula removal
A fistula is a tunnel or passageway that forms, connecting one part of your body to another (typically involving the intestine or anus in IBD patients), or to the outside surface of your body. This often occurs because of an abscess (collection of pus) that has caused a tunnel that drains the pus or infected area. A fistula is seen more often in Crohn’s disease than in ulcerative colitis. Fistulae will need to be treated immediately to prevent serious infections or other problems from developing. Fistulae treatment options include medications, surgery, or both. If surgery is the best option, the type of surgery performed will depend on where the fistula is located. Your doctor will discuss the best options for you to consider. There are many potential surgeries for the treatment of fistulae. Some examples include:
Using a special plug to close the fistula and allow it to heal
Tying a thin surgical cord (also known as a seton) to help drain any infection in the fistula so it can heal
Opening up the fistula by making an incision along its length so it can heal
Using glue to close the fistula
Sometimes stool needs to be diverted to allow for healing. This is usually done with an ileostomy, bringing the small intestine up through the abdominal wall, allowing waste to leave your body through a stoma, a surgically created hole. An ostomy pouching system is used to collect the feces. This is generally used as a temporary measure to allow healing. Additional surgery may be required to ensure the area where the fistula was originally is closed.

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