There are two main types of (IBD) Inflammatory Bowel Disease: Ulcerative Colitis and Crohn's Disease. The approaches to surgery and indications for surgery are different in each case. Our approach is that your original organs are always optimal as long as they are functioning properly. When they are not, it is appropriate to consider the role of surgical therapy. All of our surgeries are performed at the Brigham and Women’s Hospital main campus, at 75 Francis Street in Boston.
Surgery for Ulcerative Colitis
Ulcerative colitis affects only the rectum and colon. It is a disease of the lining of the large intestine and does not affect deeper layers of the bowel or the small intestine. Most of the time, ulcerative colitis can be successfully treated with medical therapies. When these medical therapies are not enough, surgery can be offered. The surgery for ulcerative colitis can involve removing either parts of the colon or the entire colon and rectum. Doing this is often termed “curative” because the diseased area has been removed. If just the affected area of the colon is removed, it is called a resection. This is usually done in one procedure and can be done as an open surgery or often as a laparoscopic surgery.
In instances where a much larger section of the colon and rectum are involved, the entire colon and rectum are removed and often reconstructed. In most cases the anus can be preserved with an ileoanal pull-through. This surgery is usually done in two stages. At the first operation, the affected area of the colon and or rectum are removed and then a portion of the small intestine can be used to make a "neorectum" and this is then connected to the anus. A temporary ileostomy bag is then created. After approximately 8-12 weeks, this temporary bag can be taken away and then the patient can then evacuate in a normal fashion.
Ileoanal J-pouch for ulcerative colitis
This specialty procedure is offered to patients who have ulcerative colitis or familial polyposis. Patients with ulcerative colitis who have not responded sufficiently to medical therapy can have this procedure done in two or three stages. In the first stage, the colon or the colon and rectum are completely removed. A new rectum called a "J-pouch" is then created and then "anastomosed", or hooked up, to the muscles of continence (anal sphincters). Usually a temporary, diverting ileostomy, or bag, is created upstream from this complicated surgery so that it can heal without infection. Between 6-12 weeks of this initial procedure, the temporary ileostomy, or bag, is taken away with a smaller operation and the patient can return to evacuating in a normal fashion.
Surgery for Crohn's Disease
Surgery for Crohn's disease also is performed when medical therapies are not enough. Sometimes patients with Crohn's disease will get a narrowing of their intestines called a "stricture". When this occurs, and it is unable to be treated with medications, surgery is then used to either remove or, in some cases, widen the bowel. Particularly with Crohn's disease of the small intestine, bowel preserving surgery is emphasized. Other areas of the gastrointestinal tract that are involved with Crohn's disease include the colon, rectum and anus.
Along with antibiotics, anorectal problems are often treated surgically to drain infection. Once the infection is cleared, more aggressive medical treatments can then be started. In particular with Crohn's disease, we work in close conjunction with our surgical colleagues since a combination of surgical and medical procedures are often needed in order to maximize a patient's therapy.