Surgical Intervention in Crohn's Disease
Last month we talked about the surgical intervention in the treatment of UC. This time we will discuss how surgery can play a role in the treatment of Crohn's Disease. Different that surgical intervention in UC, surgery is not a cure for people dealing with Crohn's. In most cases of Crohn's surgical intervention is used as a way to reduce symptoms or treat complications from the disease.
The Crohn's and Colitis Foundation of America (CCFA) estimates that 66-75% or Crohn's patients will have one or more surgery in their lifetime. The most typical operation in Crohn's is the bowel resection. During this procedure the diseased portion of bowel is removed and the corresponding portions are then reconnected. This does not prevent the disease from recurring in the portion of bowel that were previously unaffected but it can provide some symptom relief for a time. The CCFA estimates that the recurrence of Crohn's in patients who have had these kind of procedures is up to 80% by 20 years. In two years the recurrence is measures at approximately 20% and at three years it is thought to be as high as a 30% recurrence of symptoms (1).
Other procedures which may be considered include the strictureplasty, in which the surgeon widens the intestines to help prevent blockages, and the proctocolectomy with ilesostomy. As mentioned in the UC blog during a protocolectomy both the large intestine and rectum are removed. During this type of surgery a stoma may be placed. A stoma is a hole or opening to the outside of the body. In this case an ostomy bag will be worn externally to collect stool. The newer procedure to create a pouch (called an Ileoanal pouch anastomosis) can prevent the need to wear the ostomy bag. In Crohn's the rate of recurrence is believed to be higher in those who chose to have the re-anastomosis (1,2).
As with any surgery the risks and benefits have to be weighed carefully with your physician. The rate of recurrence also must be discussed and weighed in patients with Crohn's facing surgical intervention. Though not for everyone, it is possible that surgery can help relive symptoms or treat complications of the disease. This may provide a better quality of life for those suffering from this often debilitating disease.