Inflammatory Bowel Disease Surgery

There are different types of surgery used to treat IBD. For Crohn's disease, surgery is necessary at some point in the lifetime of about half of persons with this disease. Surgery can relieve symptoms or correct problems like blockages or bleeding in the intestine. Surgery to remove part of the intestine can help Crohn's disease but cannot cure it. The inflammation tends to return next to the area of intestine that has been removed. Therefore, people considering surgery should carefully weigh the risks and benefits compared to other treatments.

Types of surgery for Crohn's disease include:

• Colectomy (colon removal) - A part of the colon or the entire colon and rectum may be removed. A colostomy or ileostomy may be done after the diseased colon is removed. A colostomy or ileostomy creates an opening on the abdomen (stoma) for the drainage of stool (feces) from the large intestine (colon) or small intestine (ileum) and may be temporary or permanent.

• Small bowel resection - The diseased parts of the small bowel can be removed and the two healthy ends are sewn back together. If it is necessary to spare the intestine from its normal digestive work while it heals, a temporary opening (stoma) of the intestine onto the abdomen (ileostomy) may be done. A temporary ileostomy will be closed and repaired later. If a large portion of the bowel is removed, the ileostomy may be permanent.

For ulcerative colitis, persons with severe cases of this disease may need surgery to remove the diseased colon. Some of the IBD-related problems that cause health care providers to consider surgery include growth retardation, steroid dependency, serious medication side effects, cancer or pre-cancerous changes, disease that is unresponsive to medication, narrowing of the colon, and extraintestinal disease (disease caused by IBD in areas outside of the digestive tract).

Types of surgery for ulcerative colitis include:

• Colectomy, or colon removal (see Colectomy, Types of surgery for CD, above). About 25 to 40 percent of people with ulcerative colitis must have surgery to remove the colon because of bleeding, severe illness, rupture of the colon, or risk of cancer. For years, individuals who had colons removed had to wear a "bag" outside their bodies to collect waste from the digestive system. Recent surgical techniques make that no longer necessary in the vast majority of persons with CD.

• Ileoanal pouch anastomosis (IPPA) - The colon and interior of the rectum is removed during this surgery. An internal pouch is created from part of the ileum (the end of the small intestine), by pulling a portion of the ileum through the wall of the rectum and attaching it to the anus. This allows a person to continue to eliminate waste through the anus. While some people can have this surgery done all at once, this procedure is usually done in two stages. The colon and interior of the rectum are removed and a temporary ileostomy is created. Once the pouch has healed (about six to eight weeks), the temporary ileostomy is closed, restoring waste elimination through the anus.