What is Crohn’s disease?

Crohn’s disease causes inflammation of your bowel. The disease most often affects the end part of your small bowel, called the terminal ileum. However, it can affect any part of your bowel.

Crohn’s disease causes your bowel wall to thicken, which can block food from passing through. The affected area of your bowel can also fail to absorb nutrients from your food.

What are the benefits of surgery?

Your symptoms should improve. Your doctor may also be able to reduce or stop your medication.

Are there any alternatives to surgery?

Inflammation can be treated using medication such as mesalazine, steroids, azathioprine and infliximab. These have side effects and your doctor will discuss them with you.

Sometimes a narrowing of your bowel can be stretched by a procedure that uses a flexible telescope and a balloon dilator.

What will happen if I decide not to have the operation?

• Abdominal pain and bloating.
• Diarrhoea.
• Weight loss.
• You may get a hole through the wall of your bowel, which can cause an abscess or an abnormal connection (fistula) to develop between your bowel and another organ.
• Your bowel may get completely blocked.
• You may get problems with your back passage.
• There is a small increase in the risk of developing bowel cancer.
• You may get problems with other areas of your body.

What does the operation involve?

The operation is performed under a general anaesthetic.

Your surgeon will make a cut on your abdomen and remove the diseased part of your bowel.

Your surgeon will usually join the ends of your bowel back together. If they are unable to join the ends of your bowel, they will make a colostomy or ileostomy (your bowel opening onto your skin).

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious.

General complications of any operation

• Bleeding during or after the operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Acute kidney injury.
• Developing a hernia in the scar.
• Blood clot in your leg (deep-vein thrombosis - DVT).
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs.
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.
• Difficulty passing urine.

Specific complications of this operation

Keyhole surgery complications

• Damage to structures such as your bowel, bladder or blood vessels when inserting instruments into your abdomen. If an injury does happen, you may need open surgery.
• Developing a hernia near one of the cuts used to insert the ports.
• Surgical emphysema (a crackling sensation in your skin caused by trapped carbon dioxide).
• Gas embolism. This is when gas (carbon dioxide) gets into the bloodstream and blocks a blood vessel.

Complications of surgery for Crohn’s disease

• Anastomotic leak. This is a serious complication. You will often need another operation.
• Continued bowel paralysis (ileus), where your bowel stops working for more than a few days, causing you to become bloated and to be sick.
• Damage to other structures inside your abdomen.
• Injury to your bowel.
• Tissues can join together in an abnormal way (adhesions) when scar tissue develops inside your abdomen.
• Compartment syndrome causing pain and damage to your legs.
• Death. The risk is less the fitter you are.

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You should be able to go home after 3 to 10 days.

It may take up to 3 months for you to recover fully. Most people feel much better after the diseased part of their bowel has been removed.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Crohn’s disease sometimes comes back and affects another part of your bowel or a part near to where the join was made.

Summary

Crohn’s disease causes inflammation of your bowel. Surgery is usually recommended if medication fails to improve your symptoms.

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