Surgical treatment options for Crohn’s disease or ulcerative colitis (UC) are reserved for patients for whom medical therapy is ineffective, intolerable, or in cases where complications such as bleeding, intestinal obstruction, or perforation have occurred.
Most surgical procedures involve removing the involved areas of the intestine and connecting the two remaining ends of the healthy intestine (anastomosis).
In some circumstances when connection of the intestines is impossible or unsafe, an ostomy (stoma) is created. These procedures may be performed with an incision via the traditional open approach or via laparoscopic surgery (minimally invasive surgery). The choice between open versus laparoscopic surgery depends on many factors, including disease progression and your health status.
Any intestinal surgery is associated with certain risks, such as complications related to anesthesia, bleeding, infection, or leakage from the intestinal connection (anastomosis). Risk is determined in part by the nature of the specific operation and the individual’s general health. Function of the ostomy may be affected by weight fluctuation.
Most abdominal operations for Crohn’s disease or UC at UT Southwestern Medical Center are performed via the laparoscopic (minimally invasive surgery) approach, but this is decided with your surgeon.
The most common surgical procedures are:
- Abdominoperineal resection (APR): In APR, the sigmoid colon, rectum, and anus and removed. After this procedure, the patient will have a permanent colostomy. This operation is performed for certain rectal cancers, as well as Crohn’s disease or UC that is unresponsive to medical treatments, and other conditions. During this operation, the diseased portion of the colon is removed and the healthy ends of the colon are connected together.
- Small bowel resection: Resection is a procedure in which the diseased small intestine is removed. The healthy ends are connected to each other. This operation is commonly performed with Crohn’s disease.
- Total abdominal colectomy: In colectomy, the entire colon is removed and either the ileum (the terminal portion of the small intestine) is connected to the rectum or an ileostomy is created. This operation is performed for Crohn’s disease, UC, and other diseases of the colon.
- Total proctocolectomy with ileoanal pouch or with end ileostomy (UC only): In these procedures, the entire colon and rectum are removed, and the ileum is either connected to the skin as an ileostomy, or a J-Pouch is constructed and connected to the anus to function as a new rectum. This operation is usually performed in stages and will require a temporary ileostomy for eight weeks.
What to Expect After Colorectal Surgery
Your hospital stay can vary from three to 10 days depending on the severity of your disease, the type of surgical procedure, and your overall health. A short stay in the Intensive Care Unit (ICU) may be necessary for some patients. A team of physicians and other medical professionals will care for you throughout your hospitalization.
Following the operation you will have some pain, which will be most severe for the first 1 to 2 days. You will be given adequate intravenous (IV) analgesics via a patient-controlled analgesia pump. You may also have a pain pump inserted around the incision at the time of surgery. The pump will later be removed.
A nasogastric tube (a tube into your stomach through the nose) is unlikely, but you will have a bladder catheter to drain urine for the first day or two following the operation. You will also have an IV to give you fluids and medications following the operation.
You will likely be allowed to drink clear liquids the evening of the operation. As the function of your intestinal tract returns, you will be allowed to progress to solid foods. You should immediately stop all oral intake if you feel abdominal bloating, nausea, or feel like vomiting. These sensations will resolve as the intestinal function returns following the operation.
You will be assisted out of bed and into a chair the morning following the operation. You will also be asked to walk down the halls. This may initially be somewhat difficult due to pain, weakness, and dizziness, but it will become easier and will facilitate your recovery. You will be discharged from the hospital once you tolerate a regular diet, have bowel function, and your pain is controlled with oral medications.