What Is the Role of Surgery?

Two-thirds to three-quarters of patients with Crohn's disease will require surgery at some point during their lives. Surgery becomes necessary in Crohn's disease when medications can no longer control the symptoms. It may also be performed to repair a fistula or fissure. Another indication for surgery is the presence of an intestinal obstruction or other complication, such as an intestinal abscess. In most cases, the diseased segment of bowel and any associated abscess is removed; this is called a resection. The two ends of healthy bowel are then joined together in a procedure called an anastomosis. While resection and anastomosis may allow many symptom-free years, this surgery is not considered a cure for Crohn's disease, because the disease frequently recurs at or near the site of anastomosis. An ileostomy also may be required when surgery is performed for Crohn's disease of the colon. After the surgeon removes the colon, he brings the small bowel to the skin, so that waste products may be emptied into a pouch attached to the abdomen. This procedure is needed if the rectum is diseased and cannot be used for an anastomosis. The overall goal of surgery in Crohn's disease is to conserve bowel and return the individual to the best possible quality of life.