Surgery for Inflammatory Bowel Disease

For many people, the complications of Crohn’s disease result in the need for surgical intervention to prevent the disease from progressing and posing a serious risk to your health. Complications include an abscess, or a collection of pus and bacteria; a perforation, or a tear in the intestinal wall; a fistula, a hole in the intestinal wall that breaches another nearby organ; or an obstruction. 

Surgery to address these complications is not a cure for Crohn’s disease, and the disease may return even after surgery. However, surgery can remove all active Crohn’s disease, improve the health of the intestinal tract, and significantly improve symptoms. Since many people may experience a recurrence of the disease after surgery, close monitoring and follow up is extremely important.

During a small bowel resection, a surgeon removes the damaged part of the small intestine. Often, this surgery is done using a laparoscopic technique, in which a surgeon makes very small incisions in the abdomen. He or she inserts a laparoscope—a thin, flexible instrument with a light and camera on the end—through one of these incisions. The camera sends live images to a nearby monitor, giving the surgeon a clear view of the interior of the abdomen.

The surgeon inserts tiny surgical instruments through another small incision and uses them to remove the damaged section of the intestine. If enough of the healthy intestine remains, the free ends may be joined together. Most of the time, there is enough healthy intestine to reconnect. 

If there is not enough healthy intestine, a surgeon performs a procedure called an ileostomy to divert your small intestine through an opening in the abdomen. That opening is called a stoma. This allows intestinal contents to drain into a sealed pouch on the outside of the body. The ileostomy may be temporary or permanent, depending on a doctor’s assessment of the health of the bowel after surgery.

Small bowel resection is performed using general anesthesia. You typically remain in the hospital for three to five days for observation while you begin to heal.

What to Expect After Surgery

Immediately after surgery, NYU Langone pain management specialists help you control postoperative pain and remain comfortable while you recover. If you had an ileostomy, our team of ostomy specialists helps you adjust to the ostomy bag and answers any questions you may have about how it works. 

If an ileostomy is temporary, you need another surgical procedure to reverse it and reconnect the intestine to the rectum after it has healed from the resection. Typically, this procedure takes place two or more months after the first surgery. During this time, doctors schedule follow-up appointments every one or two weeks to monitor the intestine as it heals. NYU Langone’s specialized ostomy team is available to provide assistance and support during this time. 

If Crohn’s disease causes a buildup of scar tissue that blocks part of the intestinal tract, doctors may recommend intestinal strictureplasty to widen the area and restore bowel function. The procedure may also be recommended if severe inflammation in the gastrointestinal tract narrows the small intestine to the point that digested food and other material can’t pass through. Strictureplasty does not require the removal of any intestinal tissue.

There are several approaches a surgeon may take to perform strictureplasty, depending on the length and location of the stricture, or narrowed area. Our surgeons determine the appropriate technique based on diagnostic imaging tests. 

The result of strictureplasty is the elimination of the obstruction in the small intestine. Surgery is performed using general anesthesia. You should expect to remain in the hospital for a few days while the incisions heal. NYU Langone pain management specialists ensure that you recover comfortably during this time.

Colectomy is a procedure to remove part or all of the large intestine, or colon. If inflammation has damaged the rectum, a surgeon may remove it as well, a procedure called proctocolectomy. Both procedures are performed using general anesthesia.

Doctors may recommend colectomy for people with Crohn’s disease or ulcerative colitis. They decide if colectomy is appropriate based on the results of diagnostic tests and whether the disease has progressed despite medication.

Colectomy is most often recommended for people with ulcerative colitis who have excessive bleeding in the intestine or rectum and do not respond to medical treatment. Because ulcerative colitis is limited to the colon, doctors consider colectomy a cure for the disease.

For those with Crohn’s disease, doctors may recommend colectomy if ulcers, infection, or strictures in the large intestine don’t respond to medication. Colectomy may relieve symptoms of Crohn’s disease for months or years, but it is not considered a cure because the disease may affect any part of the gastrointestinal tract.  

What to Expect During Surgery

A surgeon may perform a colectomy using a minimally invasive laparoscopic technique, in which he or she makes several small incisions in the abdomen. The surgeon then inserts a laparoscope—a thin, flexible instrument with a light and camera on the end—through one of the incisions. The camera sends live images to a nearby monitor, giving the doctor a clear view of the interior of the abdomen.

If a surgeon requires more direct visualization of the colon, he or she makes a longer incision in the abdomen to reach the colon directly. This is called an open technique.

In either approach, the surgeon removes the diseased part of the colon. If some of the colon is healthy, the surgeon performs a partial colectomy and removes only the diseased part of the colon. If IBD has progressed throughout the entire colon, he or she may perform a total colectomy. If the colon and rectum are damaged, both are removed. Most people still have a functioning digestive system after surgery.

If the colon and rectum have been removed, the surgeon may need to perform an additional procedure to help the body process waste. For people with ulcerative colitis, this procedure is called an ileal pouch anal anastomosis, also called J-pouch surgery. For those with Crohn’s disease, a surgeon may perform an ileostomy.

To perform J-pouch surgery, a surgeon uses part of the small intestine to construct an internal pouch that remains permanently within the abdomen. This pouch mimics the function of the rectum by providing a place for waste to collect and allows people to pass waste through the anus. This procedure avoids the need for a permanent ileostomy.

Because Crohn’s disease affects the small intestine, an ileal pouch would be vulnerable to becoming infected or diseased. Surgeons perform an ileostomy instead. In this procedure, the surgeon creates an opening in your abdomen, called a stoma. The end of the small intestine, called the ileum, is attached to the stoma. This allows stool to exit your intestine through the opening.

Waste collects in an external pouch called an ostomy bag that is worn around the waist. An ileostomy may be temporary or permanent. A doctor determines the next steps based on the results of the surgery, your age, and your overall health.

A temporary ileostomy allows the intestine to rest and heal. When your intestine has healed fully, a surgeon may perform another operation to rejoin the ends of the intestine. In some instances, he or she may be able to create an internal pouch to collect and store stool, mimicking the function of the rectum and restoring the ability to pass waste through the anus.

Doctors determine whether this is possible based on a number of factors, including how much of the colon was removed, how far the disease has progressed in other areas of the gastrointestinal tract, and your overall health.

What to Expect After Surgery

Immediately after surgery, NYU Langone pain management specialists and ostomy nurses help you control postoperative pain and adjust to the ostomy bag. You should expect to remain in the hospital for two to five days for observation while you begin to heal.

While you are in the hospital, our ostomy team provides support and answers any questions you have about living with an ostomy bag. Most people can easily conceal the bag beneath their clothing.

For those with a temporary ileostomy, the second surgery typically occurs two or more months later. During this time, doctors schedule follow-up appointments every one or two weeks to monitor the intestine as it heals.