Surgery for Crohn’s

Crohn’s surgery is usually done to treat complications like strictures, fistulas, abscesses, or severe disease that does not respond to medicine. It does not cure Crohn’s, but it can relieve symptoms, prevent emergencies, and improve quality of life. This article explains when surgery is considered, the main operations used, and what postoperative care and recurrence prevention typically involve.

Key Takeaways

• Surgery treats complications of Crohn’s, such as blockage, perforation, abscess, or cancer, and is not considered a “failure” of medical therapy. (journals.lww.com)

• The most common operation is resection, where the diseased bowel segment is removed and the healthy ends are joined or brought out as a stoma. (journals.lww.com)

• Strictureplasty widens narrow segments without removing bowel and helps preserve length when there are many small bowel strictures. (ncbi.nlm.nih.gov)

• Good preoperative preparation focuses on nutrition, anemia, infection control, steroid reduction, and smoking cessation to lower surgical risks. (academic.oup.com)

• After surgery, blood clot prevention, early movement, pain control, nutrition support, and a clear plan for restarting Crohn’s medicines help recovery and reduce recurrence. (academic.oup.com)

Why surgery is part of Crohn’s care

Even in the biologic era, a significant number of people with Crohn’s eventually need major abdominal surgery. Ten years after diagnosis, about 25 to 30 percent of people will have had at least one bowel resection, and some will need another operation later. (journals.lww.com)

Surgery can remove or bypass badly damaged areas and complications that medicines cannot fix. However, Crohn’s is an immune-driven condition that can return at the edges of the surgery or in a different segment of bowel. Surgery treats complications and symptoms, but it does not erase the underlying disease.

Importantly, modern guidelines stress that surgery is one tool in a long-term plan, not proof that medical treatment has “failed.” In some situations, early surgery for short, localized disease can be an appropriate first choice instead of escalating to stronger drugs. (journals.lww.com)

When surgery is recommended

Emergency indications

Emergency surgery is done when there is an immediate threat to health, such as: (journals.lww.com)

• A severe bowel blockage that does not improve with medical care

• A perforation (hole) in the intestine with leakage of bowel contents

• Uncontrolled bleeding from the bowel

• An abscess that cannot be drained safely by radiology or that keeps returning

These situations are usually treated with urgent resection of the affected bowel, sometimes with a temporary stoma to protect healing.

Planned or elective indications

Elective surgery is scheduled when problems are serious but not immediately life-threatening. Common reasons include: (journals.lww.com)

• Repeated obstructions from strictures (fixed narrowings made of scar tissue)

• Penetrating disease, such as internal fistulas that connect bowel loops or nearby organs

• Chronic abscesses or inflammatory masses that do not resolve

• Dysplasia or cancer in a Crohn’s-affected segment

• Localized, short-segment ileocecal disease that continues to cause symptoms despite medicines

Perianal disease, such as complex fistulas around the anus, often requires combined medical and surgical care and is covered in a separate article.

Main types of Crohn’s bowel surgery

Resections

In a resection, the surgeon removes a diseased segment of bowel and either:

• Joins the healthy ends together, called an anastomosis, or

• Brings one or both ends out to the skin to form a stoma (ileostomy or colostomy)

Bowel resection is the single most common operation in Crohn’s. The typical procedures are: (journals.lww.com)

Whenever possible, surgeons aim for laparoscopic (keyhole) surgery, which is linked to faster recovery, less pain, and smaller scars compared with open surgery. For limited terminal ileal Crohn’s, laparoscopic resection is considered a reasonable alternative to long-term biologic therapy in selected patients. (academic.oup.com)

Strictureplasty

A stricture is a narrowed segment of bowel. When the narrowing is mainly scar tissue and Crohn’s inflammation is controlled, surgery may be needed to prevent or treat blockage.

Strictureplasty widens the narrowed segment without removing it. This preserves bowel length, which is important for people who already had several resections or have long segments of disease. (ncbi.nlm.nih.gov)

Surgeons choose among several techniques based on stricture length: (ncbi.nlm.nih.gov)

• Heineke–Mikulicz strictureplasty for short strictures, usually under 10 cm

• Finney strictureplasty for medium-length strictures, about 10 to 20 cm

• Side-to-side isoperistaltic strictureplasty (Michelassi type) for long segments over 20 cm

Large reviews show that strictureplasty is generally as safe and effective as resection for suitable strictures and reduces the risk of short bowel syndrome from repeated resections. (pubmed.ncbi.nlm.nih.gov)

Ostomies (stomas)

An ostomy is an opening on the abdominal wall where bowel is brought to the skin so stool empties into a pouch. Ostomies may be:

• Temporary, to protect a new anastomosis, divert stool away from severe perianal disease, or allow inflamed bowel to rest

• Permanent, if the colon and rectum are removed or if the anus can no longer function safely

Specialized stoma nurses teach pouch care, skin care, and daily living skills. Many people return to regular activities with the right support.

Preparing for Crohn’s surgery

Good preparation can lower the risk of complications and improve recovery. Key elements often include: (academic.oup.com)

• Nutritional optimization: correcting weight loss, low albumin, or vitamin deficiencies, sometimes with supplements or tube feeds

• Treating anemia: using iron, B12, or other therapies

• Controlling infection: draining abscesses, treating sepsis before surgery

• Reducing steroid dose: high-dose prednisone before surgery is linked to more infections and anastomotic leaks, so guidelines advise tapering when possible (academic.oup.com)

• Managing biologics: current data do not show a consistent increase in complications from modern biologics, so many guidelines no longer recommend routine long holds before surgery (academic.oup.com)

• Stopping smoking: smoking worsens healing and increases recurrence risk

A multidisciplinary team, including a colorectal surgeon, gastroenterologist, anesthesiologist, dietitian, and stoma nurse, is ideal.

Recovery and immediate postoperative care

After surgery, most centers follow enhanced recovery pathways that focus on: (academic.oup.com)

• Early pain control with a mix of medicines to limit opioids

• Early mobilization, often starting the day of or after surgery

• Gradual return to oral fluids and food, sometimes very soon after surgery

• Careful monitoring for complications such as infection, bleeding, or bowel obstruction

People with IBD have a higher risk of blood clots in the legs or lungs, especially after major abdominal surgery. Current Crohn’s surgery guidelines recommend blood thinner injections during the hospital stay and often for at least 2 weeks after discharge. (academic.oup.com)

For those with a new ostomy, stoma nurses provide teaching on pouch changes, skin protection, diet, and supplies before going home.

Preventing Crohn’s from coming back after surgery

Crohn’s commonly returns at or near the connection between the bowel ends, even when symptoms are quiet at first. Ten years after a first resection, around 30 to 35 percent of people may need another surgery, although this risk is lower in the modern biologic era. (journals.lww.com)

Guidelines suggest a proactive approach: (gastro.org)

• Risk assessment: high-risk features include smoking, penetrating complications, prior resections, and extensive disease

• Early preventive medicine: anti-TNF biologics and thiopurines are well studied; newer agents like vedolizumab and ustekinumab also show benefit

• Continuing biologics around the time of surgery and restarting soon after appears to lower clinical recurrence compared with stopping them entirely (ecco-ibd.eu)

• Endoscopic monitoring: many societies now recommend colonoscopy or ileocolonoscopy 6 to 12 months after surgery to look for early recurrence and adjust treatment

Lifestyle measures such as not smoking, staying active, and working with a dietitian to maintain good nutrition also support long-term bowel health.

Questions to discuss with the care team

Before and after surgery, helpful questions can include:

• What exact segment of bowel is being removed or treated?

• Is a resection, strictureplasty, or both planned?

• Is there a chance of needing a temporary or permanent ostomy?

• Will surgery be laparoscopic or open, and why?

• What can be done before surgery to improve nutrition, anemia, and infection control?

• How will Crohn’s medicines be managed before and after surgery?

• When will endoscopic follow-up be done to check for recurrence?

Clear communication helps people with Crohn’s and their families understand the goals of surgery, set realistic expectations, and plan for recovery and long-term disease control.

FAQs

Does surgery cure Crohn’s disease?

No. Surgery can remove diseased segments and resolve complications, but the underlying immune condition remains. Crohn’s often recurs near the surgery site or in another bowel segment, which is why postoperative medicines and monitoring are important. (gastro.org)

How long is the typical hospital stay after bowel surgery?

Hospital stays vary with the type of surgery and individual health, but many people stay about 3 to 7 days after a straightforward laparoscopic resection. Complicated operations, open surgery, or severe preoperative illness can extend this time.

When are biologic medicines usually restarted after surgery?

The exact timing depends on healing, infection risk, and the specific drug. Many teams aim to restart or initiate biologic therapy within several weeks after surgery once wounds are healing well, since early prophylaxis lowers recurrence risk. (gastro.org)

Can someone have more than one strictureplasty?

Yes. Strictureplasty is often used at multiple sites in the small bowel to treat several strictures while preserving length. Studies show good long-term safety, with many recurrences happening in new bowel segments rather than at the strictureplasty sites. (pubmed.ncbi.nlm.nih.gov)