One type of surgery that a doctor may recommend for people with Crohn's disease is bowel resection. This procedure involves removing part of the small intestine.
In this article, we discuss what a bowel resection is and what to expect before, during, and after the procedure. We also cover risks and complications, outlook, and other types of surgery for Crohn's disease.
What is a bowel resection?
Bowel resection removes a part of the small intestine.
A bowel resection is a surgical procedure that doctors use to treat some people with Crohn's disease.
When inflammation affects the intestines, it can sometimes cause strictures. Strictures are sections of the intestines that become narrower due to significant inflammation, and they block the passage of digested food. Untreated strictures can lead to severe pain and cramping.
On either side of an intestinal stricture, there may be healthy tissue. During a bowel resection, the surgeon removes only the damaged part of the intestine and then joins together the two healthy ends.
When is a bowel resection necessary?
According to the National Institute of Diabetes and Digestive and Kidney Diseases, it is common for people with Crohn's disease to need surgery. Research suggests that around 60 percent of individuals have surgery within 20 years of receiving a diagnosis of Crohn's.
A doctor may recommend surgery for people with strictures that do not respond to standard treatments. A bowel resection may be necessary when other types of surgery, such as strictureplasty, have not been effective or are not a suitable option.
A stricture can slow down the digestion of food and cause several symptoms, including:
- abdominal pain and cramping
- nausea and vomiting
These symptoms can become very severe in some people and may lead to potentially dangerous complications, such as a hole, or perforation, forming in the wall of the intestine.
A doctor may also recommend a bowel resection to treat people with fistulas. A fistula is an abnormal tunnel that forms between two different parts of the intestine or connects the intestine to another organ.
Fistulas can occur following severe inflammation of the intestinal wall and can become infected. During a bowel resection, the surgeon will focus on removing this tunnel and the damaged tissues around it.
Surgery for Crohn's disease can improve symptoms and help induce remission, which is an extended period without symptoms. For some people, this symptom-free period can last for many years.
If a bowel resection is successful, it should completely remove the stricture or fistula from the intestines. However, it is still possible for another stricture or fistula to return afterward, either in the same area or in a different part of the intestines.
How to prepare
A person may have to fast before surgery.
Depending on the circumstances, a doctor may make specific recommendations for a person to prepare for the surgery. These may involve changes in the type or dosage of current medications. The doctor may also prescribe new medications or antibiotics to help prevent infection.
A person may also need to clear out their intestinal tract the day before the surgery. Doctors may advise the person to use an enema, drink plenty of water, or drink a special solution that helps clear the intestines.
Most surgeries require the person to fast for a set period before the surgery. The doctor will let the individual know if they need to fast and for how long.
Before fasting, it is best to eat healthfully and avoid foods that may irritate the digestive tract.
Before the surgery begins, an anesthetist will place the person under general anesthesia. Anesthesia will make the individual unconscious, and they will not feel any pain during the procedure.
There are two main types of small bowel resection: laparoscopic and open surgery.
Laparoscopic surgery involves making a small incision into the person's abdomen. The surgeon then inserts a laparoscope and small surgical tools through the hole. The laparoscope is a thin tube with a camera and light on the end, which allows the surgeon to see inside the abdomen using a monitor so they can operate.
During open surgery, the surgeon makes a larger incision and performs the procedure with standard surgical equipment.
After the surgeon has performed the bowel resection, they will close up the incision with stitches and apply a dressing.
After a bowel resection, the person will typically stay in the hospital for about a week. Doctors will monitor the person to ensure that the surgery was successful and that there are no complications.
When the individual leaves the hospital, doctors will often prescribe pain medications and antibiotics to support their body as it recovers. They may also give the person specific instructions and tips regarding the healing process. Recovery then continues at home.
A person should quit smoking during recovery.
Full recovery from a bowel resection takes time, often up to 2 months. During this time, doctors will want to regularly check in with the person to discuss how their recovery is going.
In general, doctors will recommend that the person avoids activities that put stress on the abdomen, such as heavy lifting or strenuous physical activity. They may also give the person additional recommendations about exercise.
During recovery, the intestine needs to heal. A specific diet may help reduce the stress on the intestine, aiding the healing process.
The doctors will give the person guidelines on what to eat or avoid. In general, the guidelines will recommend eating soft, easy-to-digest foods, such as potatoes, rice, and pasta.
A doctor may also reevaluate a person's current medications and recommend changes as necessary. They will advise people to quit smoking as their intestine heals.
Risks and complications
A few complications may occur as a result of the surgery. For instance, the person may react to the anesthetic. Infections and bleeding are also possible at the surgical site.
Rarely, the area where the surgeon rejoined the intestines may come apart or leak. This complication is potentially life-threatening and requires immediate treatment. Other possible complications include kidney failure or fistulas.
The surgery may also lead to another complication called short bowel syndrome. The small intestine is responsible for absorbing nutrients from the food into the bloodstream. Removing too much of the intestines can lead to nutritional deficiencies in some people.
A bowel resection has the potential to offer people many years of symptom relief. However, symptoms can eventually return.
According to the Crohn's & Colitis Foundation, symptoms reoccur in approximately 50 percent of adults within 5 years of a bowel resection. The inflammation usually affects the part of the intestines where the surgery took place, but it may occur elsewhere.
Medications can help treat these symptom flare-ups, but some people may require a second operation. A doctor can advise on possible treatment options if symptoms do come back.
Other types of surgery for Crohn's disease
Other surgical procedures are available to treat Crohn's disease. These include:
For many people with a stricture, a bowel resection may not be necessary. Instead, a doctor may recommend a strictureplasty, which is a type of surgery that widens the narrowed area without removing part of the intestine.
If Crohn's disease is severely affecting a person's colon, a doctor may recommend a colectomy. This procedure involves removing all or part of the colon. The surgeon will then either rejoin the healthy parts back together or attach the rectum directly to the small intestine.
If severe inflammation is affecting both the colon and the rectum, the complete removal of both organs may be necessary. The surgeon will then connect the end of the small intestine to a hole in the lower abdomen so that stool can safely exit the body.
For some people with Crohn's disease, a doctor may recommend a small bowel resection for treating severe complications, such as strictures and fistulas. The surgery involves removing the damaged part of the small intestine and then rejoining the healthy parts.
If successful, a bowel resection may allow the person to live for years without symptoms. However, symptoms can return in some people, and a second operation may sometimes be necessary.
It is essential for a person to take care of their body before surgery and during recovery to give it the best chance to heal. Working closely with the doctor can help support proper recovery and reduce the risk of complications.