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Crohn's disease surgery: options and recovery
Surgery for Crohn's disease removes or opens up the most damaged section of bowel, most often the end of the small bowel (an ileocaecal resection). It is used for narrowing, fistulas, abscesses or disease that drugs cannot control. It does not cure Crohn's, but it can give years of good health, and for limited disease it can be as good an option as long-term biologic drugs.
When surgery is considered
- Stricture: scarred narrowing causing pain, bloating and vomiting after meals.
- Fistula: a channel to another loop of bowel, the bladder, vagina or skin.
- Abscess: often drained under scan guidance first, then followed by planned surgery.
- Disease not controlled by medicines, or medicines causing unacceptable side effects.
- Dysplasia or cancer, uncommon, in long-standing Crohn's colitis.
Surgery is no longer a last resort. In the LIR!C trial, keyhole ileocaecal resection was a reasonable alternative to infliximab for people with limited ileal disease not responding to standard treatment. Decisions are best made jointly by your gastroenterologist and surgeon.
The operations
| Operation | Used for |
|---|---|
| Ileocaecal resection | Disease at the end of the small bowel, the commonest site. Usually keyhole. |
| Strictureplasty | Short narrowings, especially multiple ones. Widens the bowel without removing it, preserving length. |
| Segmental or total colectomy | Crohn's affecting the colon. |
| Perianal surgery | Abscess drainage and seton placement for fistulas, often combined with drug treatment and guided by pelvic MRI. |
The guiding principle is to remove as little bowel as necessary. A stoma is not usually needed, though a temporary one may be advised if you are on high-dose steroids, malnourished or have an abscess.
Preparing for surgery
- Nutrition is optimised, sometimes with a liquid diet beforehand.
- Steroids are reduced where possible; biologic timing is planned with your gastroenterologist.
- Stopping smoking reduces both complications and recurrence.
Recovery
After keyhole surgery most people eat and walk within a day, go home after three to six days, and return to desk work in two to four weeks. Avoid heavy lifting for around six weeks.
Preventing recurrence
Crohn's commonly returns near the join over the years. A colonoscopy around six months after surgery, as in the POCER trial approach, detects early recurrence so treatment can be stepped up before symptoms return. Higher-risk patients, such as smokers or those with penetrating disease, often start a biologic soon after surgery. Newer ways of fashioning the join, such as the Kono-S anastomosis, are being studied for their effect on recurrence.
Mr Papettas's audited bowel surgery results:
| Measure (Mr Papettas, audited) | Result |
|---|---|
| Major bowel resections as first surgeon | 500+ |
| Anastomotic leak rate | Under 1% (national range 3 to 8%, NBOCA) |
| Elective mortality | 0% |
| Operations completed by keyhole | 95% |
| Conversion to open surgery | Under 5% |
Full methodology and benchmarks: bowel resection outcomes and audited results.
Common questions
Will surgery cure my Crohn's disease?
No. Surgery treats the damaged segment and often gives years of remission, but Crohn's can recur elsewhere, most often near the join. Follow-up colonoscopy and sometimes medication reduce this risk.
Will I need a stoma?
Most people do not. A temporary stoma is sometimes advised if you are on high-dose steroids, are malnourished or have an abscess at the time of surgery.
Can Crohn's surgery be done by keyhole?
Yes, in most cases, including many repeat operations. Keyhole surgery means less pain, a shorter stay and fewer adhesions.
Should I have surgery or start a biologic?
For short-segment ileal disease, both are reasonable options and evidence supports either. Discuss the choice with your gastroenterologist and surgeon together.
This guide is general information, not personal medical advice. If you have severe abdominal pain, heavy bleeding, a high temperature or vomiting, call 111, or 999 in an emergency.