Biologic drugs have made it easier to manage Crohn's disease, but surgery is still sometimes needed. Almost half of people with Crohn's will need surgery within 10 years after their diagnosis, even if they take medicine. Some will need more than one surgery.
Resection surgery removes the parts of your intestine that Crohn's disease has damaged. It's not a cure, but it can treat complications and help you feel better.
What Is Resection Surgery?
During resection, your surgeon removes the parts of your intestine that are narrowed or scarred, and attaches the two healthy ends together.
There are three kinds of resection surgery. The procedure you have depends on the part of your intestine Crohn's has damaged.
- Small bowel resection removes a piece of your small intestine.
- Large bowel resection removes part of your large intestine, which includes your colon.
- Ileocecal resection removes the end of your small intestine and the first part of your colon, called the cecum. Your appendix might also need to come out because it's attached to the cecum.
Why You Might Need Surgery
Surgery is an option if medicine and other treatments haven't helped your symptoms, or you have complications like these:
Narrowing in your intestine. Crohn's disease can inflame the intestine so much that it swells up and doesn't leave enough room for stool to pass through. This narrowing is called a stricture.
Perforation. The intestine wall can get so damaged and weak that a hole forms. A perforation needs to be treated right away so that it doesn't get infected.
Abscess. Inflammation in the wall of the intestine can cause an infection. An abscess is a pocket of pus that collects during an infection.
Fistula. This is when a sore grows through the intestine wall and forms an abnormal tunnel to another organ, such as the anus or bladder. Sometimes abscesses cause fistulas.
Perforation and abscess are more serious. They may need emergency surgery.
What to Expect
Part of the preparation for resection surgery is to eat a low-residue diet for a few days. This diet limits high-fiber foods like whole-grain breads, nuts, and seeds, which are hard to digest. If you take medicines to suppress your immune system, you may need to stop taking them before surgery.
Resection surgery is done in one of two ways:
Open surgery. The surgeon makes one large cut in your belly and removes the damaged section of intestine.
Laparoscopic surgery. The surgeon makes a few small cuts in your belly. A scope with a camera and light on the end goes into one of the openings, and tiny instruments go into the others. The camera lets the surgeon watch on a monitor as they remove the damaged section of intestine.
After either type of procedure, the surgeon sews or staples the two healthy ends of the intestine together. If there isn't enough healthy intestine left to reconnect, you may need a second procedure to create an opening or pouch to store and remove waste.
Recovery
You'll stay in the hospital for 3 to 7 days after your surgery. Take it easy for a few weeks while your body heals. Your doctor will tell you how long you need to wait before going back to work and exercising.
Eat foods that are easy to digest to help your intestines heal. Your doctor or a dietitian can give you advice on what to eat during your recovery.
Possible Complications
Any surgery has possible risks and side effects, including:
- Bleeding
- Infection
- Damage to nearby organs
- Blood clots
- Trouble breathing
- Scars
Resection surgery has a few specific side effects, including:
- A blockage in the intestines
- Leaks in the area where the intestines are attached
- A hernia – a piece of the intestine that pushes through the incision and forms a lump
- Bleeding or an abscess in the belly
Short bowel syndrome (SBS) is a complication of small bowel resection. The small intestine is where your body absorbs nutrients from food. If your surgeon removes a big piece of your small intestine, you may not be able to absorb enough nutrients when you eat. SBS causes symptoms like weight loss, diarrhea, kidney stones, and weakness.
Not everyone will have side effects or complications. Your risk depends on the type of surgery you had, your health, and how the procedure was done. Laparoscopy may cause fewer complications than open surgery.
Smoking increases the risk for post-surgery complications. If you smoke, quitting before your surgery could improve your outcome and reduce your need for another surgery.
Call your doctor if you have any of these warning symptoms after resection surgery:
- Fever
- Bleeding, swelling, warmth, or drainage from the surgery site
- Swelling in your belly
- Nausea or vomiting
- Bloody or black poop, or no poop
- Shortness of breath
Life After Resection
Resection surgery helps to relieve Crohn's symptoms, sometimes for many years. Most people who've had this surgery said it improved their quality of life, and that they would be willing to have the surgery again if they needed it.
Crohn's disease symptoms can come back, which is called a recurrence. It can recur in the spot where the surgeon connected the two healthy parts of your intestines. Your doctor can monitor you for a recurrence with endoscopy – viewing the inside of your GI tract using a flexible tube with a camera attached.
There are things you can do to avoid a recurrence and another surgery. Quitting smoking is one. Taking a type of biologic drug called a TNF-inhibitor might also reduce the chance. Ask your doctor what else you can do after resection surgery to keep your Crohn's disease under good control and prevent complications.