Medically reviewed by Shannon Chang, MD
Surgery is actually much more common for people with Crohn’s disease than it is for people with ulcerative colitis. If you have Crohn’s and your doctor recommends surgery, the surgery is very likely to relieve your symptoms; however, Crohn’s may come back.
Why You Might Need Surgery
The two most common reasons doctors recommend surgery for people with Crohn’s are:
- Due to chronic changes in the bowels from inflammation, such as an abscess (a pocket of infection) or a fistula (a tunnel or tract created between two organs)
- Because of a stricture (an obstruction or blockage in the intestine)
Other reasons, though rather rare, can include excessive intestinal bleeding or toxic megacolon, both of which are medical emergencies. Toxic megacolon may be more likely if you are taking antidiarrheal medicines.
Surgery is performed to remove the diseased portion of the gastrointestinal tract, such as a portion of your small intestine or colon or, at times, the entire colon.
Surgery for Strictures
If your Crohn’s has resulted in a complete or partial blockage causing a narrowing in a section of your intestines, then the blockage can be resolved either by removing the section that is blocked or, less frequently, by doing a strictureplasty.
Small Bowel Resection
This is the most common surgery for Crohn’s, in which a portion of the intestine is removed, usually to remove a complete or partial blockage. A resection can provide relief from Crohn’s symptoms for many years.
After this surgical procedure, you’ll still need to have regular checkups with your gastroenterologist, because the Crohn’s may become active again even if you don’t feel symptoms. Your doctor most likely will want to do a colonoscopy about six months after surgery to see how your body is doing, with follow-up colonoscopies annually.
For people who do experience a recurrence after small bowel resection surgery, the inflammation and symptoms often can be treated with medication (immunomodulators or biologics are the most common); however, about half the patients who experience a recurrence after surgery may require a second surgery.
This is a less common surgical treatment for strictures, in which the surgeon widens the narrowed section of the bowel without removing any portion of the intestine. Strictureplasty is considered safe, but about half of the patients who undergo this type of surgery will require surgery again.
Perianal Abscesses and Fistulas
In Crohn’s disease, inflammation can affect the area around the rectum and anus, leading to fistulas (tunnels of inflammation that may drain pus or stool) and abscesses (pockets of infection).
If you develop a fistula, an “exam under anesthesia” may need to be performed. This is usually an outpatient procedure in which the abscess is drained and a plastic string called a seton is inserted into the fistula tract. This keeps the tube open and prevents pus pockets from forming. Generally, this procedure is very safe and quite effective at relieving the pain associated with fistulas. Antibiotics also may be prescribed.
Some fistulas can be drained and then the tract can be “opened” to allow the fistula to heal via a fistulotomy. This procedure also is done under anesthesia.
Benefits Often Outweigh the Risks
Though many people with Crohn’s avoid surgery until it is the only option left, they often find that the benefits largely outweigh the risks. The vast majority of people experience long-term relief from their symptoms.
Even for the roughly half of those who undergo surgery for Crohn’s and then experience a recurrence of symptoms within five years, that’s still a long time to feel better during day-to-day life.
Many people with Crohn’s have found that a combination of medication and surgery can result in the best quality of life, allowing them to lead a healthier, more active lifestyle.
Medical reviewer and Oshi physician-partner Shannon Chang, MD is a gastroenterologist specializing in IBD at NYU Langone Health’s Inflammatory Bowel Disease Center in New York City. Her clinical interests include J-pouches, pregnancy in IBD, and in-patient IBD management. Dr. Chang is an Assistant Professor of Medicine, as well as the Associate Program Director for the Gastroenterology Fellowship. She completed her internal medicine residency at Mount Sinai Hospital and her gastroenterology fellowship at NYU.
Oshi is a tracking tool and content resource. It does not render medical advice or services, and it is not intended to diagnose, treat, cure, or prevent any disease. You should always review this information with your healthcare professionals.