This page is in progress, stay tuned for more information on the different types of surgery . . .

Surgery

Surgery should be discussed at any stage in the “step up approach” or “top down approach”.  Surgery should not be considered a “failure of treatment” – as in many cases, surgery may be the best option for the person.  IN some cases, medications may be started “too late” in the disease course, after complications (e.g. strictures) have already developed – in these cases, surgery AND medications together may be the best option

 

Resection

Resection is a surgery to remove a section of the intestines.  Small bowel resection means a piece of small bowel is resected.  Common parts of the intestine to be resected are strictures, diseased areas, areas with pre-malignancy.  People with Crohn’s disease may have history of multiple small bowel resections due to removal of strictures, fistulizing areas, inflammed areas.

 

Stricturoplasty

Strictures are often resected, but in some cases they are cut open and sewn up in the other direction (plasty) to keep them open.

 

Colectomy

Colectomy is a surgery to remove the colon.   Hemicolectomy means only half the colon is removed.  Subtotal colectomy means most of the colon is removed, but the rectum is left inside.  Subtotal colectomy is performed in cases of emergency or if the intent is to have a second surgery to create an internal pouch.  Total colectomy means the entire colon including the rectum is removed.

 

Ostomy

Ostomy refers to the creation of a stoma, or an opening of the intestines to the skin to allow passage of stool.  Ostomy can be ileostomy (the ileum exits the skin) or colostomy (the colon exits the skin).

Ostomies can be temporary or permanent.   A temporary ileostomy typically is a loop or diversion ostomy, meaning that a loop of intestine is brought out to the skin and everted (turned on itself) to produce the spout).   Diversion ostomy is sometimes used to allow the large bowel or perianal disease to heal, as the stool will be passed through the ostomy and not pass through the colon.  With a permanent ileostomy or end-ileostomy, the stoma creation is permanent, meaning no plan to reconnect and reverse the stoma.   To create a stoma, surgeons will pull the end of the small intestine through the surgical opening, out of the abdomen, turn it on itself (evert), and suture – so that it protrudes out like a spout – this allows the intestinal feces and content to exit and flow away from the stoma/skin connection.

Hospital and clinic resource websites 

Zane Cohen Centre, Mount Sinai Hospital, Toronto, ON – Rachel Flood Education Program in Ostomy

What is an ostomy?

What is an ileostomy?

What is a colostomy?

Living with an ostomy

 

Organizations that support people with ostomies:

Ostomy Canada

Ostomy Toronto

Vancouver United Ostomy Association

Bad Gut Society (BC) ostomy section

Crohn’s Colitis Canada

Some useful handouts created by health care and hospital organizations as well as some of the above organizations:

Living with an Ostomy (Crohns Colitis Canada)

A Handbook for New Ostomy Patients (from Vancouver Chapter of United Ostomy Association)

A Handbook for New Ostomy Patients (from Ostomy Toronto)

Leaving Hospital after ileostomy surgery (Health Care at Home)

Eating after ileostomy (University Health Network, Toronto Hospitals)

Nutrition after Ileostomy (Providence Health Care, Vanocouver Coastal Health)

 

Some handy tips about living with an ostomy are available at the following websites, which are created by people with ostomies:

Vegan Ostomy

Ostomy Guide

Newbie Ostomy

 

Some of the major ostomy supplies manufacturers have educational materials for ostomates:

Coloplast Care

Convatec

Hollister

Hollister – Love and Sex with an Ostomy

Hollister – Ostomy and pregnancy and childbirth

 

 

Pouch creation

People who had colectomy often will have an internal pouch created.  This is most often the case in people with ulcerative colitis, rarely do surgeons create pouch in Crohn’s disease.  The most common pouch or Ileal Pouch Anal Anastomosis (IPAA) is the J-pouch, called J due to the shape.    The pouch is created from the small bowel and eventually acts as a reservoir for stool. 

People with an internal pouch still have bowel motions about 4 to 6 times a day, but the disease burden is removed.    Some people do develop inflammation of the pouch or “pouchitis” which can be treated with antibiotics and other medications.   Although colectomy and pouch creation is considered a “cure” for ulcerative colitis, some people may develop Crohns disease of the pouch, in which case immunosuppressants and biologics are often used to treat the disease.

 

Incision and drainage

Incision and drainage or I and D refers to a small surgery where the skin above an abscess is cut or incised open, and the abscess drained.  I and D are done frequently to treat perianal abscesses.

More information about Surgery and IBD are available at

Zane Cohen Centre – Mount Sinai Hospital, Toronto

University of Alberta IBD Unit – Surgery

 

What about IBD surgeries and pregnancy?

Click here for more information on IBD surgeries and pregnancy.