Crohn's disease

Ileocecal resection

  ADAPTED FROM CROHN'S AND COLITIS UK

ADAPTED FROM CROHN'S AND COLITIS UK

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.
 

 

Stricturoplasty

  ADAPTED FROM CROHN'S AND COLITIS UK

ADAPTED FROM CROHN'S AND COLITIS UK

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.

 

Resection

  ADAPTED FROM CROHN'S AND COLITIS UK

ADAPTED FROM CROHN'S AND COLITIS UK

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.

Ulcerative colitis

Restorative Proctocolectomy with ileo-anal pouch

 adapted from crohn's and colitis UK

adapted from crohn's and colitis UK

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

 Adapted from Crohn's and colitis UK

Adapted from Crohn's and colitis UK

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.

 

 

 

Colectomy with ileo-rectal anastomosis

 adapted from crohn's and colitis uk

adapted from crohn's and colitis uk

This operation is much less common because it is only suitable for a small number of people with UC. This is a less complex procedure compared to other options with lower morbidity rates, but it has been considered in highly selective patients with reasonable clinical results.

This surgery does not involve extensive pelvic dissection, unlike other interventions. In addition, the pelvic nerve damage is minimized, avoiding the sexual and urinary dysfunction. However, this operation will only be recommended if there is little or no inflammation in the rectum and no long-term risk of developing rectal cancer.

In this surgery the colon is removed, but instead of creating an ileostomy, the surgeon joins the end of the small intestine directly to the rectum. This avoids the need for an ileostomy creation.

 

Colectomy with ileostomy

 ADAPTED FROM CROHN'S AND COLITIS UK

ADAPTED FROM CROHN'S AND COLITIS UK

This procedure is often performed in the emergency settings. 

During this operation the surgeon removes the colon but leaves the rectum. Then, similarly to a proctocolectomy, the end of the small intestine is brought out through an ileostomy and an external bag is fitted onto this opening to collect the waste from digestion. The upper end of the rectum is either closed or brought out to the surface
to another temporary stoma. This is called a mucous fistula and is needed because the rectum may produce mucus for a while.

Depending on the patient's individual medical condition, the ileostomy may be temporary or can become permanent. Once the patient have recovered from the colectomy and a decision to revers the stoma is made, s/he may be able to have IPAA as described above which will help to restore the continuity of the gut. Alternatively, patient and surgeon may decide on a permanent ileostomy.

 
To learn more about various aspects of surgery in IBD, please, go back to the IBD Surgery page

To go back to the IBD Unit main page click here

References and Acknowledgments