It is fairly common for Crohn’s disease to affect both the terminal ileum (the last part of the small intestine) and the caecum. If the inflammation is severe and persistent, then it may be necessary to remove that part of the intestine.
The healthy end of the small intestine is then joined directly to the colon (large intestine). This operation is also known as an ileal caecectomy.
This is a way of treating strictures and blockages in the small intestine which avoids removing any gut.
The surgeon opens up the narrowed section of the intestine with a lengthwise cut, and then reshapes it by sewing it up the opposite way. Food can then pass freely through the reshaped section of the intestine.
When compared to bowel resection, strictureplasty has definite advantage of preserving small bowel length and capacity to absorb macro- and micronutrient, vitamins, and may help protect against short bowel syndrome in patients at risk for undergoing future multiple bowel resections.
If the stricture is long, or there are several strictures close together, a resection may be preferable to a strictureplasty.
In a resection the surgeon removes the damaged and diseased part of the gut, and then sews (or staples) together the ends of the remaining healthy sections.
This join is called an anastomosis.
Restorative Proctocolectomy with ileo-anal pouch
Commonly called "pouch surgery"or IPAA (ileo pouch- anal anastomosis) surgery, this procedure is the most common in patients with UC because of the acceptable and durable functional outcomes.
The main advantage of a pouch is that faeces (stools) can be passed through the anus in the normal manner, although usually more frequently.
Generally, it requires two surgical interventions. In the first and main operation the surgeon removes the whole colon and the rectum, but leaves the anus. Then a pouch is made using the ileum (the lower end of the small intestine) and this is joined to the anus. Finally, a looped section of the small intestine is brought out onto the external wall of the abdomen through a temporary ileostomy. This allows the waste from digestion to be collected in a stoma bag until the newly-formed pouch has had a chance to heal – which generally takes about three months. The second operation is performed in order to close this temporary ileostomy.
Total Proctocolectomy with ileostomy
During this operation the entire colon is removed, together with the rectum and the anal canal. The end of the small intestine is brought out through an opening in the wall of the abdomen. This is called an ileostomy or stoma.
An external bag is then fitted onto the opening to collect the waste. It can be emptied or changed as necessary. Click here to learn more about Ostomy Care.