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Surgical treatment of Crohn's disease


Surgery - just one of the possible treatments for Crohn's disease. About three-quarters of patients diagnosed with Crohn's disease they need surgery at some point in their lives, even if they take all the necessary medications and eat right. Surgery does not cure a patient of Crohn's disease, but surgery does. significantly improves patients ' quality of life.

When is surgery necessary?
Surgery may be required for several reasons. The most common cause is the ineffectiveness of drug therapy and the development of complications:

  • intestinal obstruction due to the formation of intestinal stricture;
  • massive intestinal bleeding;
  • perforation of the intestine with the development of peritonitis;
  • formation of fistulas between organs that normally do not communicate with each other;
  • infectious complications and development of sepsis;
  • toxic megacolon.

A patient may choose surgery if Crohn's disease makes his daily life difficult or if taking medication causes many side effects. Often, a doctor may recommend surgery if there is a high risk of colorectal cancer in patients with a long history.
There is no universal operation for the treatment of Crohn's disease, the type and scope of surgery depends on:

  • reasons why surgery is necessary;
  • severity of disease;
  • localization of the lesion.

Several types of operations for Crohn's disease:

  • Stricturoplasty: in this operation, part of the intestine is not removed, but plastic surgery is performed to expand the narrowed part of the intestine. 
  • Elimination of fistula in most cases, fistulas in Crohn's disease are located either between different parts of the intestine or between the intestines and the bladder or skin. As a rule, to eliminate fistulas, it is necessary to remove part of the organ where the fistula is located. 
  • Colectomy: performed when most or all of the colon is affected, while the rectum is preserved, an anastomosis is formed between the ISIL and rectum. The operation can be performed in one or two stages, depending on the severity of the disease and the patient's condition. 
  • Coloprotectomy surgery to remove the entire colon (colon and rectum), which culminates in the formation of a terminal permanent ileostomy. 
  • Resection of the small or large intestine part of the small or large intestine affected by Crohn's disease is removed. Also, the operation can be one-or two-stage (at the first stage, resection is performed and a stoma is formed, at the second stage, a reconstructive operation is performed). 
  • Abscess drainage very often Crohn's disease is complicated by the formation of abscesses in the abdominal cavity, retroperitoneal space or pelvis. The operation must be performed urgently and its essence lies in the removal of pus by installing tubular drainage into the cavity of the abscess.  
  • Ileo-or colostomy it can be either a temporary or permanent measure, depending on the amount of surgery performed.

Surgery for Crohn's disease, as with any other surgical pathology, has its pros and cons. In the postoperative period, complications such as:

  • infectious wound complications and anastomosis failure;
  • bleeding (from the anastomosis zone, from the mesentery vessels);
  • obstruction (both dynamic and early adhesive);
  • vitamin B12 deficiency;
  • early and late parastomal complications (prolapse, retraction, stricture, hernia, etc.).

Surgery does not guarantee that the patient will no longer have symptoms of Crohn's disease. Approximately 30% of patients who undergo surgery, symptoms resume within the next 3 years, and 60% – within 10 years. 
But the benefits may outweigh the risks and disadvantages. Depending on what type of intervention the patient has undergone, in the postoperative period, you can expect reducing the intensity of pain up to its complete cupping, reducing the frequency of diarrhea, vomiting and fatigue. Perhaps a patient after surgery will be able to take fewer medications, in some cases stop taking those drugs which have many side effects. After the operation there is the possibility of expanding the diet

Deciding on surgery for Crohn's disease is always difficult, but surgical treatment should be timely. A personalized approach in the treatment of patients with Crohn's disease is the key to a successful outcome and prognosis of the disease, reducing the frequency and severity of complications, improving the quality of life.

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