Now through January when
you post to THE WALL,
you'll be entered for a
chance to win an
iPod touch®!

Add your post

See Terms of Use for contest rules and more details.

Surgery Options for IBD

It is important to understand the fact that surgery for inflammatory bowel diseases (IBD) is not the "last ditch" treatment. Many people with IBD endure discomfort needlessly because they try to avoid surgery at all costs.

The truth is, if medical therapy alone no longer keeps your disease under control, then surgery may be the way to achieve long-term symptom relief.

There are several types of surgery available, and determining which one is right for you will depend on:

  • Whether you have Crohn's disease or ulcerative colitis (UC)
  • The location of the disease in the intestines
  • The type of complication you have
  • The severity of your illness

Surgery options for Crohn's disease

  1. Strictureplasty: If an area of the bowel narrows, this widens the area without removing any portion of the small intestine.
  2. Resection (removing portions of the intestines): This involves removing affected areas of the intestine, and then joining together the two ends of healthy intestine in a procedure called anastomosis.
  3. Colectomy (removing the colon) or proctocolectomy (removing the colon and rectum): If only the colon is affected, a colectomy may be needed. But if the colon and rectum are affected, a proctocolectomy may be needed, along with ileostomy — bringing the ileum (end of the small intestine) through a stoma (opening) in the abdominal wall to allow drainage of intestinal waste out of the body. After the procedure, an external bag must be worn over the opening to collect waste.
  4. Surgery for abscesses and fistulas: Sometimes abscesses (pus-filled mass) need to be removed surgically. And surgery may be required if a fistula (abnormal tract) is causing symptoms that don't respond to medication.

Surgery options for UC

  1. Proctocolectomy (removing the colon and rectum) with ileostomy: If UC is severe, surgery may be required to remove the entire colon and rectum, plus bring the ileum (end of the small intestine) through a stoma (opening) in the abdominal wall to allow drainage of intestinal waste out of the body. The second part of the procedure is called ileostomy. After the procedure, an external bag must be worn over the opening to collect waste.
  2. Restorative proctocolectomy, also known as ileoanal pouch anal anastomosis (IPAA): This surgery involves removing the colon and rectum, but the patient can continue to pass stool through the anus — in place of an ileostomy, the ileum is fashioned into a pouch and pulled down and connected to the anus.

Benefits & risks of surgery for Crohn's disease

Potential benefits

  • Long-term symptom relief
  • Reduced frequency or dose for ongoing medication
  • Healthier, more active lifestyle
  • Combination of medication and surgery often can give people with Crohn's the best quality of life

Potential risks/side effects

  • Surgery-related complications, as with any surgery
  • About 50% of adults will have recurrence — usually at site of anastomosis or ileostomy — of symptomatic disease within 5 years of resection surgery
  • About 50% of people with recurrence will need another surgery
  • Psychological implications for those with ileostomy

Benefits & risks of surgery for UC

Potential benefits

  • Long-term symptom relief
  • Surgery to remove diseased intestinal tissue actually represents a "cure"
  • Reduced or even eliminated need for ongoing medication
  • Healthier, more active lifestyle

Potential risks/side effects

  • Surgery-related complications, as with any surgery
  • Potential complications specific to IPAA include:
    • Pouchitis (inflammation of the pouch)
    • Small bowel obstruction (can occur from adhesions or scar tissue from surgery)
    • Pouch failure in 8%-10% of patients
    • Difficulty getting pregnant
    • Even if colon has been removed, may still have 5-6 soft bowel movements per day
  • Psychological implications for those with ileostomy

If you think surgery may be the right choice for you, talk to your doctor to learn more about your options, and the benefits and risks of each.