Surgery for IBD
IBD sometimes requires surgery as a means of controlling symptoms or dealing with IBD-related complications such as abscesses and fistulae. Historically, surgery has been a common treatment option, however, advances in treatments such as the increasing use of various biologics (e.g., infliximab, adalimumab) has meant that surgery rates have decreased. Although surgery is considered a more ‘drastic’ intervention –it is an effective means of removing diseased tissue, treating complications, and can result in long periods of remission, or in the case of ulcerative colitis –potentially permanent symptom relief. Other potential advantages include avoiding having to take drugs and their side effects, and less dietary restriction (i.e., you may be able to eat foods that previously exacerbated or triggered symptoms).
The types of surgery available for a patient with IBD depends on the characteristics of the diagnosis, i.e., the location and severity of affected areas, as well as the presence of any complications. Surgery is considered an option when:
- There is little/poor response to drug treatments
- Strictures have formed (i.e., narrowing of the bowel) obstructing the passage of food/waste through the bowel
- The patient has developed complications such as abscesses or fistulae
- There are emergency complications such as bowel perforation or obstruction
A strictureplasty involves making a lengthwise cut along a narrowed (i.e., stricture) section of bowel and the re-joining the incision in such a way that widens that section of the bowel. This procedure allows food/waste to pass through the bowel unobstructed. If the stricture can be reached with an endoscope (i.e., during a colonoscopy), the bowel may instead be widened using a special balloon that inflates.
A resection involves removing a section of the diseased bowel and then reconnecting the adjacent healthy bowel. This type of procedure is conducted under general anaesthetic and can take a few hours. Recovery involves staying in hospital for 5-7 days afterwards, where pain, food and fluid intake is managed –you may also work with a physiotherapist, as movement stimulates blood circulation and aids in the recovery process.
Stoma surgery involves bringing a section of bowel to the surface of the abdomen and creating an opening (i.e., stoma) through which faecal matter may pass through enter a stoma ‘pouch’. The idea of having a stoma can be a frightening prospect for patients –concerns about odour, stigma, and interference with work or leisure activities are common. Stomas come in different types, depending on the section of bowel that is brought to the abdominal surface. These include colostomy, where the large bowel or colon is involved, and Ileostomy, wherethe terminal ileum (i.e., final section of small bowel before the colon) is brought to the surface.
Fistula and abscess surgery
A fistula is an abnormal channel that can develop between the bowel, the skin, other organs or the skin. This can involve perianal fistulas (i.e., channel between the anal canal and the skin adjacent to the anus), bowel-to-bladder fistulas (enterovesicular), bowel-to-vagina (enterovaginal) fistulas, bowel-to-skin (enterocutaneous; e.g., abdominal surface) fistulas, and bowel-to-bowel (enteroenteric/enterocolic) fistulas. Treatment depends on the location of the fistula and can include removing the affected tissues or draining infection/inserting a seton (a type of thread allowing for drainage). Abscessed are a type of inflamed pus-filled cavity that can develop in response to inflammation. Treating an abscess is done by draining the infected area and administering antibiotics.