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HIBD Horizon

Part 2 · Getting treatment today · 10/22

Surgery, no taboos

Which operations, why, and what happens in Crohn's and UC.

An operation is not a failureIt is a treatment like any other, sometimes the best one. Well prepared and done at the right time, it can give back years of quality of life.

In Crohn's

The damaged area is removed or repaired

Ileocaecal resection

The most common: the diseased end of the ileum is removed and the bowel is stitched back together. Often by keyhole surgery (laparoscopy, small scars).

Strictureplasty

A stricture is widened without removing any bowel, to keep its full length.

Anal fistulas and abscesses

Drainage, and placing a seton: a small soft thread that stops the abscess coming back while the treatment takes effect.

Crohn's can come back near the join: preventive treatment and a colonoscopy at around 6 months are often offered.

In UC

The colon and rectum are removed

Proctocolectomy

The colon and rectum are removed. UC can no longer affect the colon, but the pouch can become inflamed and some signs outside the gut may persist.

Ileoanal pouch

A reservoir made from the small intestine replaces the rectum: no bag on the belly. Often done in 2 or 3 stages, with a temporary stoma.

And afterwards?

About 4 to 7 stools a day, sometimes one at night. Inflammation of the pouch (pouchitis) is possible: it is treated well, often with antibiotics.

After an ileoanal pouch, female fertility may fall: discuss it beforehand if you plan to have children.

When is surgery done?

As an emergency

Perforation, an abscess that won't heal, bowel obstruction, a very severe flare of UC that does not respond to treatment.

Planned

A fibrous (scarred) stricture that causes problems, disease that resists treatment, or lesions at risk of cancer.

A stoma, for real

The bowel is attached to the skin of the belly and the stools go into a bag. It is often temporary. You can work, do sport, swim, travel and have an intimate life. The bag cannot be seen under clothes. In France, the afa has a peer-support network for people with a stoma.

Getting well prepared

Stop smoking: one of the most effective ways, along with preventive treatment, to stop Crohn's coming back.
Correct anaemia or malnutrition before the operation.
Reduce cortisone if possible, with your doctor.
Choose a centre that often operates on IBD (in France, a CHU, i.e. a university hospital).

Questions to ask the surgeon

Which operation, and by keyhole surgery?
Will there be a stoma? Temporary or permanent?
How many days in hospital, and how long before going back to work?
What treatment afterwards, to prevent it coming back?