This is the fifth part of our mini-series about the condition based on our patient booklet “Fast Facts for Patient and Their Supporters: Inflammatory Bowel Disease”. Surgery can be life-saving and life changing by improving quality of life.
Surgery for Ulcerative Colitis
This involves removal of the entire colon and rectum (colectomy). Surgery often cures the disease, but only about 20% of patients need it.
Surgery May Be Performed for the Following Reasons
- Emergency surgery when the disease becomes life threatening or cannot be controlled by drug therapy. These urgent or semi-urgent situations usually arise at first presentation or in the first couple of years.
- Elective (non-urgent/planned) surgery in later years when the disease can no longer be adequately controlled with drugs.
- Elective surgery following the detection of precancerous changes or early cancer at a colonoscopy check-up.
In many cases, the surgery can be performed by keyhole surgery (laparoscopy). The large bowel (rectum and colon) is completely removed, along with one of two surgical options.
Pouchitis (inflammation of the pouch) occurs in up to half of all patients in the first decade after colectomy and ileoanal pouch construction. It is usually mild, with lower abdominal discomfort and increased frequency of bowel movements. Most of the time it can be managed with short courses of antibiotics and/or topical steroids or aminosalicylates. Occasionally it requires biological drug therapy. Rarely, a patient with resistant pouchitis may have to have the pouch surgically removed and a permanent ileostomy instead.
Surgery for Crohn’s Disease
For Crohn’s disease, surgery is usually performed to manage complications of the disease. In some instances, surgery is an appropriate early option, particularly for disease that is confined to a specific area of the bowel (localized disease) or to an area of narrowing (stricture) and obstruction in the last part of the small intestine (short-segment disease of the ileum).
The aim of surgery is to remove the smallest possible length of diseased bowel. Occasionally, it may be possible to open up (dilate) a stricture without removing any of the bowel by inflating a balloon from the inside using an endoscope.
Alternatively, it is possible to cut along the stricture and then sew it back up crossways (stricturoplasty).
Does the disease recur after surgery? Unlike ulcerative colitis, surgery does not eliminate Crohn’s disease. The disease returns in up to half of all patients after removal of diseased segments of bowel. In most instances, the disease comes back in the area where the bowel is stitched end-to-end (surgical anastomosis).
Because of the risks of recurrence after surgery, it is important to continue with maintenance drugs as prescribed by your doctor to minimize the risk of relapse.
Information based on Fast Facts for Patients and their Supporters: Inflammatory Bowel Disease (Karger, 2019).