Surgery Overview

Reviewed by: HU Medical Review Board | Last reviewed: August 2023

Surgery is frequently a part of treating inflammatory bowel disease (IBD). Of the two main forms of IBD, it is estimated that between 25 and 35 percent of those with ulcerative colitis (UC) and 70 to 90 percent of those with Crohn’s disease (CD) will need to have surgery at some point.1

In UC, the chronic inflammation is only in the colon (large intestine), and it generally begins at the rectum and spreads up the colon. In cases where UC becomes severe and the entire colon and rectum are removed (a procedure called a proctocolectomy), UC is essentially cured.2

In CD, chronic inflammation is most commonly found in the small intestine (ileum) and the beginning of the colon, although inflammation in CD can occur in patches anywhere along the digestive tract from the mouth to the anus. Surgery cannot cure CD, but it can help to treat the disease and improve the symptoms that it causes.2 Sometimes, the complications of CD can be so severe that the person needs to have surgery immediately. In other situations, the patient may make a decision to have surgery based on their healthcare provider’s advice, in order to help manage the disease and reduce their symptoms.

What IBD complications can require immediate surgery?

IBD can cause serious complications that require immediate surgery to treat.2 These include:

  • Intestinal blockage, caused by scar tissue in the intestines, strictures (narrowing of the digestive tract), or the inability for certain foods to pass through the digestive tract
  • Intestinal bleeding that cannot be otherwise controlled
  • Bowel perforation, which is a hole in the wall of the intestine caused by damage due to inflammation
  • Fistula, in which a tunnel forms between an organ (often the intestines) and the skin or other part of the body
  • Abscess, which is an area where infected pus collects
  • Toxic megacolon, a very serious condition in which the colon quickly enlarges due to severe inflammation

What is elective surgery for IBD?

Other types of surgeries for IBD are elective, which means that surgery may be recommended by doctors but the patient makes a choice about when and whether or not to have it.2,3 This can happen when medication or combinations of medications are not effective enough in controlling a person’s symptoms, or when a medication that used to work well is not working anymore. In other cases, the medication(s) may be working but their side effects are too severe or dangerous. For those people with IBD in those situations, certain types of surgeries can be considered as a way to reduce symptoms and improve their quality of life.

What types of surgeries are used to treat Crohn's or ulcerative colitis?

The most common types of surgeries used to treat IBD include:2

What is bowel resection surgery?

Bowel resection surgery is one of the most common surgeries for people with CD.1,4 It involves removing a section of the patient’s small or large intestine that is affected by the disease. During this type of surgery, the part of the intestine with active disease is removed, and the areas of healthy intestine on either side of the diseased area are surgically reattached. In many cases, this is necessary due to strictures, in which the inflammation causes damage to the intestinal wall that makes them too narrow or become blocked, preventing digested food from passing through. In other cases, bowel resection surgery may be necessary due to bowel perforation, abscesses, or fistulas.

What is strictureplasty?

Some people with CD have strictures in their digestive tracts that are not severe enough that they need to have bowel resection surgery.1,5 In those cases, they may have a common procedure called strictureplasty instead. Strictureplasty involves a procedure to widen the narrowed area of bowel rather than removing it entirely. The surgeon guides a small inflated balloon into the digestive tract to find the area of intestine where the stricture is located. Then, a small cut is made and stitched up in a way that shortens and widens the area of the stricture so that digested food can pass through the digestive tract.

What is a colectomy?

Some people with IBD have severe disease in their large intestine (colon) that medication cannot treat well enough. If their disease does not affect the rectum or anus, then having a colectomy is a surgical treatment option. During a colectomy, the surgeon removes all or part of the colon, and attaches the end of the remaining part of the intestine back to the rectum. This allows stool to pass through the anus.2,6

What is a proctocolectomy with ileostomy?

People who have severe disease that affects the colon and the rectum, and cannot be managed with medications, may consider having a proctocolectomy with ileostomy. During this type of procedure, the colon, rectum, and anus are all surgically removed. Because the patient will no longer be able to pass stool through the anus, the surgeon attaches the last part of the small intestine (the ileum) to a small opening created in the patient’s lower abdomen (called a “stoma”). A pouch attached to the stoma collects the stool that has passed through the digestive tract.2,7

What surgeries are used to treat fistulas?

Fistulas are complications of CD that require surgery to treat. The most common type of surgery for treating a fistula is called a fistulotomy, in which the surgeon creates an opening in the fistula “tunnel” to allow it to heal on its own. During a fistulotomy, the entire fistula is surgically removed. Another type of procedure called a seton placement, in which a small rubber thread (a seton) is temporarily inserted into the fistula tunnel to keep it open and allow it to heal.8

What procedures are used to treat abscesses?

Abscesses are complications of IBD in which areas of the digestive tract become infected and pus collects.9 Abscesses need to be surgically drained of the pus in order to treat the infection. This can be done with open surgery, or with a laparoscopic procedure called percutaneous abscess drainage (PAD). During PAD, a small tube called a catheter is inserted into the abscessed area to allow the pus to drain gradually, usually over a period of 7-10 days. When the abscess is fully drained, the catheter is removed.

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