Crohn’s disease is a type of inflammatory bowel disease (IBD) which causes chronic inflammation in your gastrointestinal tract (GI) from your mouth to the anus. Crohn’s disease usually affects the end of the small intestine (ileum) and the start of the large intestine or colon. Inflamed patches may occur in some areas of the GI tract whereas some areas may be left untouched. The inflammation usually affects deeper layers of the intestine and the perianal area (area around the anal canal).
Medicines usually reduce the inflammation and bring about a symptom free stage. However, if the symptoms are not controlled with medicines or complications develop, aggressive therapy such as open or laparoscopic surgery is required to treat the condition. Laparoscopic surgery is a minimally invasive procedure which involves the use of specialized instruments and a tiny video camera to treat the condition.
Surgery to treat Crohn’s disease is indicated during the following conditions:
- Intestinal obstruction or blockage
- Excessive intestinal bleeding and infection
- Bowel perforation
- Fistulas (ulcers forming a tunnel from the intestine to other organs)
Laparoscopic surgery for Crohn’s disease is preferred in non-obese individuals undergoing elective procedures and having few health problems.
Before the procedure, an intravenous (IV) tube will be inserted to deliver medicines and fluid. The laparoscopic surgery is carried out under the effect of general anesthesia. During the procedure, your surgeon inserts a small port below your navel into the abdominal cavity and inflates the cavity with carbon-dioxide gas for gaining a better view of the internal organs. A laparoscope (thin flexible tube attached to a video camera and a lighted source) is inserted through this port and additional small incisions are made for inserting specialized instruments through the abdominal wall. Based on your condition, either of the procedures such as strictureplasty, bowel resection, colectomy and proctocolectomy or fistulotomy is performed using the laparoscopic approach. After the procedure, your surgeon will remove the instruments and close the incisions.
Strictureplasty: The procedure involves widening the narrowed area of the intestine. A lengthwise incision is made along the narrowed part and sewed crosswise to widen the part of your bowel. Your surgeon may treat several strictures during a single surgery.
Bowel resection: In a small bowel resection procedure, the damaged segment of small intestine is removed and the healthy ends are joined back. In a large bowel resection procedure, the damaged segment of colon is removed and the healthy ends are stitched back together.
Colectomy and proctocolectomy: Colectomy is performed only when the colon is affected with Crohn’s disease. Your surgeon will remove the colon and join the ileum to the rectum. Proctocolectomy is performed when both the colon and rectum are affected and involves removal of the colon and rectum.
Your surgeon performs fistulotomy to treat intestinal fistulas.
After the laparoscopic procedure, you will be given medications to relieve pain and prevent infections until you recover. You may experience nausea and vomiting. You will be advised to start walking the next day to avoid complications. You should continue walking after discharge from the hospital for a faster recovery and to prevent formation of blood clots in the legs. Avoid lifting or pushing heavy objects or vigorous abdominal exercises for a few weeks after the surgery. You will have to continue follow-ups with the surgeon to monitor for the recurrence of Crohn’s disease and its complications. Your doctor may suggest either temporary or permanent diet modifications after the procedure.
As with any surgery, laparoscopic surgery for Crohn’s disease involves certain risks and complications. They include:
- Bowel obstruction
- Urinary tract infection