BOWEL RESECTION FOR INFLAMMATORY BOWEL DISEASE

Summary

Inflammatory bowel disease (IBD) is an umbrella term for conditions that cause inflammation in the digestive tract. The most common types of IBD are Ulcerative Colitis and Crohn's Disease. These conditions cause a range of digestive symptoms including, constipation, bloody diarrhoea, bowel obstructions, abdominal cramps and pain amongst others.

If medication is not effective in alleviating symptoms, or in cases where chronic inflammation has caused extensive damage to the lining of the digestive tract, surgery may be necessary.

Surgery may be considered for management of Crohn's Disease, where the goal for surgery is to achieve remission for as long as possible by removing the diseased tissue while also relieving pain and reducing complications. For Ulcerative Colitis surgery may be done for treatment by removing the diseased tissue from the intestines. Since intestines play a vital role in the body, the resection of various parts of the bowel over time may result in insufficient tissue remaining in the lower digestive tract. In these cases, resection surgery may result in the need for a colostomy or ileostomy to expel waste.

Reasons for bowel resection

Types

1Surgery for Crohn's Disease
70–75% of CD patients require surgery at some point. These surgeries are done to achieve long-term symptom relief, enhance one’s quality of life and correct complications of the disease. Surgery does not, however, cure Crohn's disease. Depending on the location of the disease in the digestive tract, the severity of the symptoms and the type of complications that have occurred, surgery may involve surgery for abscesses and fistulas, a strictureplasty, bowel resection or colectomy. While the disease often recurs, surgery followed with medication usually offers the best results and increased quality of life for these patients. Surgery can, however, lead to long-lasting remission in some patients with Crohn's disease.
2Surgery for abscesses and fistulas
Abscesses and fistulas are two types of disabling manifestations associated with Crohn’s disease. When abscesses and fistulas cause symptoms and fail to respond to medication, surgery may be needed to close fistulas, drain or remove abscesses.
3Strictureplasty
Since Crohn's Disease can occur in alternating areas of the small intestine, this can cause narrowed parts of the intestine which may become blocked. Strictureplasty, otherwise known as a bowel-sparing stricturoplasty, is a surgical procedure to widen these narrowed areas of the small intestine without resecting them.
4Bowel resection
Bowel resection may be needed to remove the diseased parts of the intestine and reconnect the healthy ends of the intestine to one another. The removal of the diseased portion of the bowel may give you relief from symptoms for many years, but recurrence near the connection site is common.
5Colectomy
A colectomy is needed when Crohn's Disease affects the large intestine, the colon. In such cases, the diseased parts of the colon may need to be removed. The remaining ends are then connected to allow for the digestive tract to function as normal. In some cases, when too much of the colon or rectum are affected, a stoma may be made in the abdominal wall to allow drainage of intestinal waste out of the body after resection of this tissue. This is known as a colostomy.
6Surgery for Ulcerative Colitis
25–30% of Ulcerative Colitis patients require surgery if medical treatment is not completely successful, or in the presence of dysplasia. Since Ulcerative Colitis causes chronic inflammation and ulcers in the internal lining of the large intestine and rectum, surgery such as a proctocolectomy or restorative proctocolectomy is done to remove this diseased tissue. These surgeries are largely curative, offering long-term symptom relief and eliminating the need for ongoing medication. These surgeries may also be done to reduce the risk of developing colon cancer.

  • A proctocolectomy is a surgery done to remove the diseased parts of the colon and rectum. In severe cases, the entire colon and rectum may need to be removed. In such cases, an opening (known as a stoma) is created near the small intestine so that intestinal waste can drain out of the body. This is called an ileostomy. This ileostomy may be permanent or temporary.
  • Restorative proctocolectomy is done as an alternative to a traditional proctocolectomy. This is also known as an ileal pouch-anal anastomosis. So instead of a stoma and the need for an ileostomy, the small intestine can be fashioned into a pouch (called a J-pouch) and pulled down and connected to the anus so that stool can be passed as normal.

Risks & Complications


Surgery for Crohn's disease


  • Possible risks related to general anaesthesia
  • Possibility of recurrence of the disease
  • The possible need for a colostomy, in which case the implications are life-changing
  • The possible need for additional surgeries



Surgery for Ulcerative Colitis


  • Possible risks related to general anaesthesia
  • The possible need for an ileostomy, in which case the implications are life-changing
  • More frequent and more watery bowel movements
  • Risks related to restorative proctocolectomy include bowel obstruction, inflammation of the pouch, and pouch failure
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