Abdominal Surgery for Crohn's Disease

What kind of surgery is done for Crohn’s disease?

If you have Crohn’s disease, you can probably manage many of your symptoms with medication and nutritional changes. But up to 80% of people with the condition will need surgery at some point. The type of surgery you need depends on the symptoms you have.

Your healthcare provider might recommend Crohn’s disease surgery if you develop complications, or if nonsurgical treatments become less effective.

Surgery for Crohn’s disease treats symptoms like:

• Intestinal strictures (narrowing of your intestines). This is the most common reason you might need surgery for Crohn’s.
• Fistulas (abnormal connections between two body parts) and abdominal abscesses (pockets of pus in the belly).
• Recurrent disease (symptoms that come back after previous treatment).

Less common reasons for Crohn’s disease surgery include:

• Gastrointestinal (GI) bleeding.
• Perforations (holes) in your intestines.
• Peritonitis (inflammation of the tissue that lines your abdominal cavity).
• Cancerous or precancerous lesions. (Crohn’s disease is a risk factor for getting colorectal cancer.)
• Toxic megacolon (when inflammation breaks down the structure of your colon).

Crohn’s disease can be frustrating. Flare-ups come and go, sometimes with no rhyme or reason — and that uncertainty can feel overwhelming at times. While surgery can’t cure Crohn’s disease, it can ease uncomfortable symptoms and allow you to do more of the things you love.

Types of surgery for Crohn’s disease

The most common surgeries for Crohn’s disease include:

• Abscess drainage. Healthcare providers use this procedure to drain infection from your abdominal cavity.
• Bowel resection. This Crohn’s disease surgery removes part of your small or large intestine. Your provider might recommend bowel resection if you have a lot of scar tissue in your intestines, or if they find cancerous or precancerous cells.
• Fistula removal/repair. A fistula is an abnormal tunnel that forms between two body parts and causes problems. Fistula removal repairs the tunnel.
• Ostomy. This surgery creates an opening (stoma) in your belly. It makes a new pathway that allows waste (poop) to exit your body through the stoma instead of through your anus (butthole). Common ostomy surgeries include colostomy and ileostomy.
• Proctocolectomy. This Crohn’s disease surgery removes part or all of your colon and rectum.
• Strictureplasty. Providers use this procedure to open up narrowed (strictured) areas caused by scar tissue, and this surgery makes the narrowing wider so poop can pass easily again.

How long does Crohn’s surgery take?

It depends on which procedure you have, the severity of disease and the affected parts of your digestive system. Your healthcare provider can tell you what to expect in your situation.

What are the benefits of Crohn’s disease surgery?

In many cases, providers can do Crohn’s disease surgery laparoscopically or robotically. This means you’ll typically have fewer incisions, fewer stitches and less postoperative discomfort.

Additionally, Crohn’s disease surgery can result in:

• Less gastrointestinal pain.
• Fewer symptoms. (Common Crohn’s disease symptoms include fatigue, diarrhea and vomiting.)
• Reduced need for medication.
• An improved appetite.
• Improved energy levels.
• Being able to go out again.
• A better quality of life.

Having surgery for Crohn’s disease doesn’t guarantee that you won’t develop more symptoms. About 20% of people who have Crohn’s disease surgery will need another procedure within five years of their first surgery.

How risky is Crohn’s surgery?

Any procedure comes with risks, including surgeries for Crohn’s disease.

Possible complications include:

• Anastomotic leak. (This can happen when two portions of your bowel don’t join properly.)
• Bacterial infections.
• Bowel obstruction.
• Excessive bleeding.
• Issues with your stoma (like your ostomy bag not attaching properly).
• Scarring, which can narrow your intestinal walls.
• Vitamin B12 deficiency. (This could happen if your surgeon had to remove a part of your intestine that absorbs vitamin B12.)

If you develop complications after Crohn’s disease surgery, your healthcare provider will help you come up with a plan. This may involve medications, nonsurgical treatments or surgery.

How long does it take to recover from Crohn’s disease surgery?

Full recovery after Crohn’s disease surgery can take anywhere from four to 12 weeks. Most people feel ready to go back to work after six weeks.

Your recovery time will depend on several factors, like:

• The type of surgery you have.
• How many surgeries you’ve had before.
• How much (if any) of your intestine needs to be removed.
• Your body’s healing capacity.
• Your age.
• Existing medical conditions.

Your healthcare provider is here to help. If you have specific questions about your treatment or recovery, reach out to them.

How long will I need to stay in the hospital?

Most people who have Crohn’s disease surgery stay in the hospital for about a week. (Some leave sooner, some stay longer.)

After your surgery, your healthcare team will:

• Monitor your healing.
• Give you IV fluids (through a vein in your arm) if you’re unable to eat or drink right away.
• Start you on a clear liquid diet when appropriate.
• Transition you to a soft food diet when you’re ready.

If you had an ostomy, a healthcare provider will teach you how to use and clean your new ostomy bag. They’ll make sure you’re comfortable with this process before they discharge you from the hospital.

Can surgery cure Crohn’s disease?

Surgery can’t cure Crohn’s disease. There’s always a chance that your symptoms will return, even after surgery.

But treatment can manage or reduce your symptoms. In many cases, it can noticeably improve your quality of life.

Your healthcare provider will work closely with you every step of the way. Whenever you have a flare-up, they’ll talk to you about treatment options and make a plan that works for you.

If surgery can’t cure Crohn’s disease, why should I have it?

If you have Crohn’s disease, you might be wondering why you should have surgery at all. The risk of not having surgery depends on your specific situation. But leaving Crohn’s disease untreated may result in:

• Abdominal pain.
• Loss of appetite and unexplained weight loss.
• Anemia.
• Poor quality of life.
• Worsening symptoms.
• Precancerous or cancerous changes to your bowel.
• An increased risk of medication side effects.
• Emergency surgery.

Some people won’t need surgery for Crohn’s disease at all. In fact, fewer people need surgery now than they did in the last two decades. This is likely due to new and improved medications and tests that can help with earlier diagnosis.

Currently, about 1 in 5 people will need surgery within the first five years of their diagnosis. Your healthcare provider is the only person who can tell you what’s appropriate in your case.

When should I call my healthcare provider?

Following Crohn’s disease surgery, you should call your healthcare provider if:

• You haven’t pooped for several days after leaving the hospital.
• You experience nausea and vomiting.
• Worsening pain.
• You notice bloody or black, tarry poop.
• You develop blood clot symptoms (like pain or swelling in your legs).

If you had an ostomy, let your provider know if it’s been over 24 hours since poop came out of your stoma. It could mean you have a blockage.

A note from Cleveland Clinic

Maybe you recently received a Crohn’s disease diagnosis. Or maybe you’ve been dealing with it for years. Either way, you might dread the thought of surgery — especially if you’ve been down this road before. It might help to talk with others who are going through the same thing. Consider finding a local or online support group and sharing stories with the millions of people who live with Crohn’s disease every day.

Crohn’s disease surgery can’t heal your condition. But in many cases, it can ease symptoms like pain, nausea and fatigue, and improve your quality of life. Your healthcare provider is here to help you decide what’s best for your situation.