Surgery for Crohn’s

Crohn’s disease can affect any part of the gut and can cause narrowings, fistulas, and abscesses. Surgery is used to treat complications or when medicines no longer control inflammation. The most common operations are bowel resections and strictureplasty. After surgery, targeted medical therapy and careful follow‑up lower the risk of disease returning at the join. (journals.lww.com)

Key takeaways

• Surgery treats complications of Crohn’s, it does not cure the disease. (journals.lww.com)

• Resection removes the worst segment, strictureplasty widens narrow segments and preserves bowel. (academic.oup.com)

• Stopping smoking, draining abscesses, and tapering steroids lower surgical risks. (academic.oup.com)

• After ileocolic resection, a colonoscopy at 6 to 12 months checks for early recurrence. (gastro.org)

• Anti‑TNF therapy, and in newer data vedolizumab, reduce postoperative recurrence in higher risk patients. (pubmed.ncbi.nlm.nih.gov)

When is surgery used in Crohn’s

Surgery is considered for bowel blockage from a stricture, persistent symptoms despite medicines, internal fistulas, abscess that cannot be controlled, perforation, heavy bleeding, or when dysplasia or cancer is found in Crohn’s colitis. Operations are planned when possible, since urgent surgery carries higher risk. A combined team, including radiology to drain abscesses, improves outcomes. (journals.lww.com)

Optimizing before surgery

• Treat and drain abscesses, then schedule elective surgery.

• Taper systemic steroids when possible to reduce infection and leak risk.

• Continue biologics, which have not shown higher postoperative complication rates in current evidence.

• Address nutrition, anemia, and smoking cessation. (academic.oup.com)

What operations are commonly done

Resection

In a resection, the surgeon removes the diseased segment, then joins the bowel ends. Ileocecal resection for limited terminal ileal disease is the most common. Laparoscopic approaches are standard in many centers. For short, accessible strictures near the colonoscope’s reach, endoscopic balloon dilation may be an alternative. (academic.oup.com)

Anastomosis technique can influence outcomes. A stapled side‑to‑side join appears to lower leaks and some recurrence outcomes versus handsewn end‑to‑end. The Kono‑S technique showed lower endoscopic recurrence in one randomized trial, although larger comparative cohorts have reported mixed results. Technique choice is individualized. (pubmed.ncbi.nlm.nih.gov)

Strictureplasty

Strictureplasty widens a narrowed segment without removing bowel, which helps prevent short bowel over a lifetime.

• Heineke‑Mikulicz: for short strictures, under about 10 cm.

• Finney: for medium segments, about 10 to 20–25 cm.

• Michelassi (side‑to‑side isoperistaltic): for long or multiple close strictures. (pmc.ncbi.nlm.nih.gov)

Strictureplasty is generally used in small bowel disease away from the colon and is avoided if there is active abscess, fistula at the site, perforation, or cancer concern. Outcomes are comparable to resection, and it can be repeated if needed. (mdpi.com)

Resection vs strictureplasty at a glance

(journals.lww.com)

What happens after surgery

Enhanced Recovery After Surgery programs, which include early feeding, early walking, and multimodal pain control, shorten hospital stay and speed recovery in colorectal operations and Crohn’s surgery. Venous clot prevention is routine. The team reviews wound care, diet advance, and return to activity before discharge. (pubmed.ncbi.nlm.nih.gov)

Preventing Crohn’s from returning at the join

Without prevention, small ulcers often reappear at the anastomosis within months. A risk‑based plan started soon after surgery lowers this risk.

• Who is higher risk: current smokers, penetrating disease at surgery, prior resections.

• What to start: anti‑TNF therapy or thiopurines are guideline‑supported options, with anti‑TNF generally more effective. New randomized data also support vedolizumab started within 4 weeks of surgery for high‑risk patients.

• What not to rely on: 5‑ASA, budesonide, and probiotics do not prevent recurrence. (pubmed.ncbi.nlm.nih.gov)

Short courses of metronidazole for about 3 months can reduce early endoscopic lesions, often as a bridge while longer‑term therapy begins, but tolerability limits long use. (pubmed.ncbi.nlm.nih.gov)

Monitoring plan after resection

• Colonoscopy at 6 to 12 months grades the join using the Rutgeerts score. Treatment is escalated if ulcers are found, even without symptoms.

• Fecal calprotectin can help track inflammation between scopes, but endoscopy guides decisions in the first year. (gastro.org)

Nutrition and bowel function after ileal surgery

After terminal ileal resection, some people develop bile acid diarrhea, which often improves with bile acid binders such as cholestyramine or colesevelam. Vitamin B12 levels should be checked over time, since deficiency risk rises with longer ileal resections or ongoing ileal disease. Multiple resections increase the risk of short bowel syndrome. (pubmed.ncbi.nlm.nih.gov)

Special situations

• Limited ileal disease: for selected patients, early laparoscopic ileocecal resection is a reasonable alternative to escalating biologics, with similar quality of life at one year and fewer surgeries later in some studies. (academic.oup.com)

• Dysplasia or cancer in Crohn’s colitis: confirmed high‑grade dysplasia usually leads to colectomy because of the high cancer risk. (pubmed.ncbi.nlm.nih.gov)

FAQs

Is an ostomy always permanent in Crohn’s surgery

No. When a stoma is used to protect a high‑risk join or to control sepsis, it is often temporary and can be reversed later. The decision depends on disease extent, rectal involvement, and healing.

What can reduce the chance of needing another surgery

Do not smoke, attend the 6 to 12 month colonoscopy, and use the recommended postoperative medicine plan. These steps together lower endoscopic and clinical recurrence and the need for further operations. (pubmed.ncbi.nlm.nih.gov)

When should urgent help be sought after going home

Fever above 101°F, severe belly pain, vomiting, rapidly worsening swelling, heavy bleeding, or a wound that looks infected should prompt urgent contact with the care team or emergency care.

Editor note: source required for local hospital recovery timelines and activity restrictions, which vary by center.