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Crohn's disease - Surgery
- Highlights
- Introduction
- Causes
- Risk Factors
- Complications
- Prognosis
- Symptoms
- Diagnosis
- Treatment
- Medications
- Surgery
Description
An in-depth report on the causes, diagnosis, treatment, and prevention of Crohn's disease.Alternative Names
Inflammatory bowel disease - Crohn's disease
Surgery:
Strictureplasty
The chronic inflammation of Crohnâ ' s disease can eventually cause scarring, which leads to narrowing in certain segments of the intestine. These narrowed areas are called strictures. If strictures do not respond to medication, a surgical procedure called strictureplasty may be used to open the blockage and widen the narrow passages.
Strictureplasty is usually performed for repairing strictures in the jejunum or ileum sections of the small intestine. It involves cutting open the strictured segment and stitching the tissue crosswise. This helps remove the area obstructing the bowel and enlarges the width of the passageway, without removing any parts of the intestine.
Resection and Anastomis
When Crohnâ ' s disease penetrates or severely inflames the bowel or colon, patients may require surgical resection. Resection is also performed for patients who have signs of small or large bowel perforation. (Perforation is when a hole in the bowel lets waste contents flow into the abdominal cavity.)
Resection involves removing the diseased section of the bowel and then reattaching the healthy ends of the intestine in a procedure called an anastomis. Resection can be performed either through open surgery involving a wide incision through the abdomen, or through less-invasive laparoscopy.
Disease Recurrence after Resection. About half of patients experience a recurrence of active Crohnâ ' s disease within 5 years of having resection and require a second surgery. The disease usually recurs near the site of the anastomis. Medications such as aminosalicylates and immunosuppressive drugs are given to help prevent or delay recurrence.
Large bowel resection - series
Click the icon to see an illustrated series depicting large bowel resection surgery.
Colectomy, Proctocolectomy, and Ileostomy
If Crohnâ ' s disease becomes extremely severe, and other treatments do not help, the patient may to have their entire colon removed. If the rectum is also affected, it will also need to be removed.
- Colectomy is surgical removal of the entire colon.
- Proctocolectomy is surgical removal of the entire colon and rectum.
Patients who have colectomy still retain their rectums and are able to pass stool naturally. Because proctocolectomy involves removing the rectum, the surgeon must perform another procedure, called ileostomy, after proctocolectomy to create an opening to allow waste to pass
Proctocolectomy with ileostomy involves the following:
- To perform proctocolectomy, the surgeon removes the entire colon, including the lower part of the rectum and the sphincter muscles that control bowel movements.
- To perform ileostomy, the surgeon makes a small opening in the lower right corner of the abdomen called a stoma. The surgeon then connects cut ends of the small intestine to this opening. An ostomy bag is placed over the opening and accumulates waste matter. It requires emptying several times a day.
Other Surgeries
Surgery may also be performed to treat fistulas or drain abscesses that have not been helped by medication, to control excessive bleeding, and to remove intestinal obstructions.
Resources
- www.ccfa.org -- Crohn's & Colitis Foundation of America
- www.gastro.org -- American Gastroenterological Association
- www.acg.gi.org -- American College of Gastroenterology
- www2.niddk.nih.gov -- National Digestive Diseases Information Clearinghouse
References
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Akobeng AK and Thomas AG. Enteral nutrition for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2007;(3): CD005984.
Baumgart DC and Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007;369(9573): 1641-57.
Behm BW, Bickston SJ. Tumor necrosis factor-alpha antibody for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2008;(1):CD006893.
Benchimol EI, Seow CH, Steinhart AH and Griffiths AM. Traditional corticosteroids for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2008;(2): CD006792.
Butterworth AD, Thomas AG, Akobeng AK. Probiotics for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006634.
Clark M, Colombel JF, Feagan BC, Fedorak RN, Hanauer SB, Kamm MA, et al. American gastroenterological association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21-23,2006. Gastroenterology. 2007 Jul;133(1):312-39.
Cummings JR, Keshav S and Travis SP. Medical management of Crohn's disease. BMJ. 2008;336(7652):1062-6.
Feagan BG, Sandborn WJ, Mittmann U, Bar-Meir S, D'Haens G, Bradette M, et al. Omega-3 free fatty acids for the maintenance of remission in Crohn disease: the EPIC Randomized Controlled Trials. JAMA. 2008;299(14):1690-7.
MacDonald JK and McDonald JW. Natalizumab for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2007;(1):CD006097.
Mahid SS, Minor KS, Soto RE, Hornung CA and Galandiuk S. Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc. 2006;81(11):1462-71.
Rahimi R, Nikfar S, Rahimi F, Elahi B, Derakhshani S, Vafaie M, et al. A meta-analysis on the efficacy of probiotics for maintenance of remission and prevention of clinical and endoscopic relapse in Crohn's disease. Dig Dis Sci. 2008;53(9):2524-31.
Sandborn WJ, Feagan BG, Stoinov S, Honiball PJ, Rutgeerts P, Mason D, et al. Certolizumab pegol for the treatment of Crohn's disease. N Engl J Med. 2007 Jul 19;357(3):228-238.
Schreiber S, Khaliq-Kareemi M, Lawrance IC, Thomsen OO, Hanauer SB, McColm J, et al. Maintenance therapy with certolizumab pegol for Crohn's disease. N Engl J Med. 2007 Jul 19;357(3):239-250.
Seow CH, Benchimol EI, Griffiths AM, Otley AR and Steinhart AH. Budesonide for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2008;(3):CD000296.
Strong SA, Koltun WA, Hyman NH, Buie WD; Standards Practice Task Force of The American Society of Colon and Rectal Surgeons. Practice parameters for the surgical management of Crohn's disease. Dis Colon Rectum. 2007;50(11):1735-46.
Yamamoto T, Fazio VW, Tekkis PP. Safety and efficacy of strictureplasty for Crohn's disease: a systematic review and meta-analysis. Dis Colon Rectum. 2007;50(11):1968-86.
Zachos M, Tondeur M and Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2007;(1):CD000542.
- Reviewed last on: 12/1/2008
- Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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