Overall, surgery for Crohn’s disease in recent years seems to be on the decline, according to a study published in December 2017 in the American Journal of Gastroenterology. But that’s mostly because the number of emergency surgeries has dropped about 10 percent each year. The number of elective surgeries, on the other hand, has increased by about 4 percent each year. The decision to have surgery for Crohn’s disease begins with the extended healthcare team — including a gastroenterologist and a colorectal surgeon — “discussing each patient individually, and recommending surgery when the patient’s quality of life is affected by the nonresponse to medication,” says Tracy Hull, MD, a colorectal surgeon and section chief of inflammatory bowel disease in the department of colon and rectal surgery at the Cleveland Clinic in Ohio. Here are some factors to consider when deciding whether to have surgery for your Crohn’s disease and choosing who your surgeon should be.
Reasons to Have Surgery for Crohn’s Disease
The most common reason for Crohn’s surgery is that medication is failing to effectively control inflammation. “Sometimes patients can cope” with disease that isn’t responding well to drugs, Dr. Hull says, “but when they start to get chained to a bathroom, then surgery is strongly recommended.” Your healthcare team may also recommend surgery if the side effects of Crohn’s medication become worse than the symptoms they’re treating, she notes. If you have an infection, bleeding, or a bowel obstruction — strong signals that your medication isn’t working, causing serious consequences — then your healthcare team will more strongly advise surgery, Hull adds. About one-third of people with intestinal inflammation from Crohn’s will experience signs of the disease in other parts of the body, such as the calves, joints, liver, skin, or eyes, says Scott Strong, MD, chief of gastrointestinal surgery at Northwestern Medicine in Chicago. If Crohn’s medication isn’t working, surgically removing the severely inflamed section of the intestine can make a difference and “hopefully, the other [inflamed] areas will quiet down” as a result, Dr. Strong notes. Inflammation from Crohn’s that goes untreated can also increase the likelihood of cancer or cause precancerous changes in the bowel. Removal of a diseased portion of the bowel may be necessary to stave off future problems, Strong adds. Surgeons may perform a relatively common operation called a strictureplasty when an area of the small intestine narrows due to inflammation. Rather than remove a section of the bowel, which can compromise the body’s ability to absorb nutrients, a strictureplasty involves a crosswise cut that ultimately causes the bowel to balloon and often reduces inflammation. More unusual reasons for Crohn’s surgery include complications that don’t respond to medication. According to the Crohn’s and Colitis Foundation, these include: Severe Bleeding This unusual condition occurs when the lining of the bowel deteriorates, exposing the layer underneath (submucosa). A surgeon can remove the affected section of the bowel. Fistula Sometimes a hole forms in the bowel at the site of inflammation. If the hole connects one section of the bowel with another or with the bladder, it’s called a fistula. Normally this isn’t a medical emergency, but if the contents of the intestine spill into the abdominal cavity, the situation can be life-threatening. Abscess If your body tries to “wall off” a perforation (breakage) in the bowel, pus and fluid can collect in the form of an abscess. If doctors can’t drain the abscess and infection sets in, you may require surgery. Severe Colitis When the colon (large intestine) becomes inflamed, sometimes the best option is to remove the entire colon. RELATED: Smart Tactics to Follow When Applying for Disability Due to Crohn’s
What to Look for in a Surgeon
If you need an operation, your main priority should be locating a colorectal surgeon experienced with Crohn’s patients, says Strong. He explains that even though X-rays and other studies help the surgeon know what to expect, surprises may await: “It’s not uncommon to find something different, or in addition to, what you knew going in.” During a procedure, surgeons need to be able to modify their approach based on what they’re finding. “That is why you’re better off with someone with experience,” says Strong. While you may not find a doctor who exclusively operates on Crohn’s patients, experts agree that it’s best to go with someone who is familiar with Crohn’s surgery and can discuss the disease and surgical options in detail. “A surgeon who is treating a complex problem like Crohn’s disease or ulcerative colitis must be experienced in order to provide the best advice to each patient individually,” Hull says. “This should be someone who operates more than occasionally on Crohn’s disease.” The surgeon should be board-certified in either general surgery or colorectal surgery, and ideally be a member of the Crohn’s and Colitis Foundation. “That tells you where their interest lies,” Strong says. A primary-care doctor or gastroenterologist should be able to offer a referral to a skilled surgeon. Other options include searching for a surgeon on the Crohn’s and Colitis Foundation website. The American Society of Colon and Rectal Surgeons can also help locate a surgeon. RELATED: 5 Ways to Build a Positive Patient-Physician Relationship When You Have IBD
Teamwork for Crohn’s Surgery Success
Once your medical and surgical team is in place, it’s important that everybody works together and communicates. “We are all members of the team — the GI doctor, the surgeon, and the patient — and the patient must feel comfortable with each member of the team,” Hull says. Be sure to include a family member or close friend in your decision-making process, and if possible, bring that person along on visits with your surgeon. Your loved one can serve as an extra pair of eyes and ears while offering moral support and helping you discuss your symptoms, recovery, and any other concerns. Having surgery for Crohn’s can be scary, but by choosing a surgeon with the right experience, learning about your options, and surrounding yourself with support, you can ensure that you’re set up for the best possible outcome. Additional reporting by Quinn Phillips.
