Learn about the common surgical prodedures used to treat Crohn’s Disease and ulcerative colitis.
Even with proper medication and diet, people with Crohn's disease or ulcerative colitis may require or opt for surgery at some point during their lives. While not a cure, surgery has the potential to dramatically improve quality of life.
The most comon surgeries are listed below. Click the name to learn how these procedures work and what these procedures look like within your body. For more detailed information on IBD surgery, see our surgery brochure.
- Small Intestine Resection
- Ileocecal Resection
- Large Intestine Resection
- Abscess Drainage
- Fistula Removal
A stricture may occur when inflammation from your disease causes the wall of the intestine to thicken, causing a narrowing in that section of the intestine. Strictures are important to treat because the narrowing could lead to a blockage that does not permit stool to pass through the body. Strictures may be treated in a surgical procedure known as a strictureplasty, where the narrowed area of the intestine is widened without removing any portion of the intestine. The surgeon makes cuts lengthwise along the narrowed area and then sews it up crosswise.
This shortens and widens that part of your intestine, allowing the food to pass through.
Small intestine resection
Small intestine (bowel) resection
A procedure where a portion of the small intestine is removed, and the two healthy ends are joined together.
The amount of small intestine that is removed depends on how much of the intestine is damaged by inflammation from the disease. This is usually performed in patients with longer segments of disease. It may also be performed to treat strictures if a patient is not a good candidate for a strictureplasty.
The last part of the small intestine (terminal ileum) is often severely diseased from Crohn’s. If this area has a stricture, fistula, or an abscess, it often requires removal in a procedure known as an ileocecal resection. During this surgery, the last part of the small intestine and the very first part of the colon (cecum) are removed and the healthy small intestine is sewn to the colon.
The appendix may also be removed because it is attached to the cecum.
Large bowel resection
Large bowel resection
A procedure where a portion of the large intestine is removed, and the two healthy ends are joined together.
A surgical procedure in which both the colon and rectum are both removed. This can be done in two ways:
- A proctocolectomy with an end ileostomy:
Once your colon and rectum are removed, your body still needs a place to expel waste. In order to do that, your surgeon will invert a piece of your small intestine. He will then make a small hole (stoma) in your abdominal wall and place the inverted tip through, so that any waste can be released outside of your body. This is process is called an ileostomy. An ostomy pouch is attached to the abdomen around the stoma to collect any waste. The surgeon will typically do this in one procedure. This procedure is less common in recent years, and many patients attempt to have a pouch constructed and have the ostomy reversed.
- A proctocolectomy with ileal pouch-anal anastomosis (IPAA)
This procedure also involves the removal of your colon and rectum, but rather than having an ostomy pouch attached to your abdomen, the end goal of this surgery is to help you continue to have bowel movements through your anus. Since the colon and rectum are removed, the small intestine needs to be attached to your anus. This can either be done with a straight join, or with an internal pouch created from the small intestine. This internal pouch would replace your rectum, where waste is stored before being expelled. The pouch is commonly shaped like a “J” so it is often called a j-pouch. Because this can be a complex surgery, it is sometimes broken up into one, two, or three stages, or operations.
- One stage procedure means that the surgeon completes all of the steps above in one operation
- Two stage procedure means that the surgeon will perform two operations:
First operation will be to remove your colon and rectum, create the internal pouch, and attach it to the anus. Then the surgeon will create a temporary hole (stoma) in your abdomen where a small piece of your intestine is inverted through it, known as a diverting loop ileostomy. Waste will be expelled into an external ostomy pouch temporarily while your intestines heal.
In the second operation, the surgeon will reverse the inverted piece of your small intestine so that waste can now move through the new internal pouch and anus.
- Three stage procedure means that the surgeon will perform three operations:
During the first surgery, the colon is removed and a temporary end ileostomy (using end of the small intestine) is created. The rectum is left behind after this procedure.
In the second surgery, the rectum is removed and an internal pouch made from the end of the small intestine. The temporary end ileostomy is reversed and a temporary diverting loop ileostomy is created.
The third surgery reverses the ileostomy and restores normal bowel function through the internal pouch.
A colectomy is the removal of your entire colon or large intestine, without removing the rectum.
Once the colon is taken out, the end of the small intestine can be joined to the rectum. This allows the person to continue to pass stool through the anus. This surgery can be done in one step, or it may need to be done in a few stages depending on the disease.
An abscess is a collection of pus that can form in the body. Some common symptoms of an abscess might include fever, pain, or you may have discharge. In order to treat an abscess, your doctor will use both antibiotics and surgery to drain the pus to allow for proper healing. The surgeon will locate the abscess, make a small cut, and insert a thin tube to drain it. Some people may have this tube for a week or more. Most people feel better within a few days.
A fistula is a tunnel or passageway that forms, connecting one part of your body to another (typically involving the intestine or anus in IBD patients), or to the outside surface of your body. This often occurs because of an abscess (collection of pus) that has caused a tunnel that drains the pus or infected area. A fistula is seen more often in Crohn’s disease than in ulcerative colitis. Fistulae will need to be treated immediately to prevent serious infections or other problems from developing. Fistulae treatment options include medications, surgery, or both. If surgery is the best option, the type of surgery performed will depend on where the fistula is located. Your doctor will discuss the best options for you to consider. There are many potential surgeries for the treatment of fistulae. Some examples include:
- Using a special plug to close the fistula and allow it to heal
- Tying a thin surgical cord (also known as a seton) to help drain any infection in the fistula so it can heal
- Opening up the fistula by making an incision along its length so it can heal
- Using glue to close the fistula
Sometimes stool needs to be diverted to allow for healing. This is usually done with an ileostomy, bringing the small intestine up through the abdominal wall, allowing waste to leave your body through a stoma, a surgically created hole. An ostomy pouching system is used to collect the feces. This is generally used as a temporary measure to allow healing. Additional surgery may be required to ensure the area where the fistula was originally is closed.
Why would I have surgery?
There may be a few reasons why surgery would be needed in Crohn’s disease or ulcerative colitis. For some people, medications may not have been helpful in controlling your disease, even though patients took their medications exactly as the doctor ordered. There may also be times where the disease has caused complications that need to be treated. While there are times when surgery is a decision that you, your family, and your healthcare team are able to plan for and decide together, there could also be cases where doctors must act fast and perform emergency surgery in order to ensure you are safe. Some people never have surgery while others have had multiple surgeries. The type of surgery you have depends on your disease and symptoms. Every person’s disease is different, and it is difficult to predict what can happen. However, you can inform yourself as much as possible so that you feel better prepared.
How will I know if I need emergency surgery?
- There is a blockage (obstruction)- your stool cannot pass through your body because it is being blocked
- There is a perforation (hole) in your intestine, that can cause a serious infection
- The symptoms and inflammation are severe and cannot be controlled with medications
- Excessive bleeding
- There is a fistula (or tunnel from your intestine to another part of your body)
- There is an abscess (or a collection of pus) that needs to be drained
Not all surgeries happen because of an emergency but when they do occur, it is usually because there is something happening in your body that could be very harmful. Surgery is urgent if:
Is surgery safe?
All surgery comes with risks, and each surgery may have different risks. Complications may include bleeding, infection, or injury to surrounding organs. Some people may have to go through multiple surgeries. Your healthcare team should talk with you about the potential risks of surgery, and what important changes you can expect in your body. You should also talk to your doctor about how you will feel immediately after surgery, any pain you may expect, and general care that will be needed as your body heals.
Will surgery cure my disease?
Surgery is not a cure for Crohn’s disease or ulcerative colitis. The goal of surgery is to help relieve symptoms and inflammation or, if it is an emergency, to keep you safe. While most people can live a normal, healthy life after surgery, remember that every individual’s disease and experiences are different. In Crohn’s patients, surgery can help relieve symptoms and/or treat complications caused by inflammation in the intestine. In ulcerative colitis, removal the colon and rectum (proctocolectomy) helps to treat the inflammation, ulcers, and other symptoms, but it does not treat the underlying inflammatory response in the body that caused the onset of IBD. Additionally, having your colon and rectum removed will require your body to heal and/or adapt to this change, and comes with other potential complications
How long will it take for me to feel like myself?
Surgery is a journey that includes preparation and recovery. If you do have surgery, it is helpful to take this journey with support from your healthcare team, or any others in your support network. Recovery will depend on the type of surgery performed but, for some people, it can take up to a year to feel back to “normal.” You may not feel 100 percent immediately, and it may take some adjustment time as you recover.
How do I prepare for surgery?
Becoming as well-informed as possible will make you feel better about the operation. It is important to ask your surgeon questions about your disease and operation, including any concerns around sexual function and fertility. There may be a specific diet you will need to follow, or foods you must avoid before surgery. There may also be changes in your medication, or supplements/vitamins that you will need to discuss with your doctor to ensure there are no complications as you undergo the procedure and enter recovery. You may also want to ensure you prepare your home so that you have all the items you will need to care for your wounds, ostomy bag, or the area of your surgery. Consider having needed supplies (bandages, bags, wound cleaning supplies, etc.) within reach so that you do not have to struggle to find them each time you need something. Think about your daily routines, such as showers, cooking, cleaning, and if possible, make plans with your support system, such as family or friends, to help you during this time. If you frequently need to lift heavy items, ensure that you know the limitations on what you’ll be able to do. Sometimes people feel more comfortable if they can ask other patients about their experiences with surgery. Your team should be able to answer your questions, and might be able to connect you with someone if needed.
What should I expect after surgery?
Recovery from surgery depends on the type of surgery performed. Most people do very well post-surgery, and after recovery are able to return to work and resume normal activity. In general, patients should expect to be on a liquid or soft diet for the first few days following surgery and then will be encouraged to slowly introduce bland solid foods into their diet. Patients will also often be on physical activity restriction for a minimum of six weeks, depending on the surgery type. For patients undergoing j-pouch surgery, an adjustment period of up to one year should be expected. Initially, there may be up to 12 bowel movements a day. Stool may be soft or liquid, and there may be urgency and leakage of stool. As the pouch gradually increases in size and anal sphincter muscles strengthen, stools will become thicker and less frequent. After several months, most people are down to six to eight bowel movements per day. The consistency of the stool varies but is mostly soft, almost putty-like. Immediately following surgery, you may receive recommendations on adjustments to your diet as your body recovers. It’s advisable to chew food thoroughly and avoid foods that may cause gas, diarrhea, or anal irritation. It’s also important to drink plenty of fluids—six to eight glasses a day, preferably between meals. It is always important to talk to your doctor about your specific needs especially as it relates to diet, and daily activities.
This resource was developed through the generous support of Bonnie & Andrew Stern.
Additional support is provided through the Crohn’s & Colitis Foundation’s annual giving program and donors.