IBD: surgery as part of treatment, everything you need to know!

What is IBD? 

The chronic condition known as Inflammatory Bowel Disease (IBD) affects the digestive system and results in intestinal inflammation. It is a serious condition that raises the risk of infection and several other complications, such as malnutrition and dehydration. IBD can be treated with surgery, and there are many different types of operations that can be used to do so.  

Difference between Ulcerative Colitis and Crohn’s disease & ways to cope with IBD without surgery.  

The two most common illnesses in the IBD category are Ulcerative Colitis and Crohn’s disease. Both conditions cause inflammation in the patient’s intestinal tract and present a lot of discomfort and pain due to the aggressive reaction of the immune system to the bacteria in the intestines. Ulcerative Colitis and Crohn’s disease are both lifelong conditions, with no cure. However, with different treatments, the symptoms of the illnesses can be managed and not affect life expectancy majorly, in most cases. Nevertheless, it is important to know, that people with IBD are at higher risk for colon cancer development and doctor checkups are highly recommended.  

The main difference between the two conditions is the location of the inflammation. Ulcerative Colitis develops in the large bowel, causing the colon and rectum to become inflamed. Crohn’s disease, on the other hand, can progress in any part of the digestive system, from mouth to anus. 

The main treatment option is medications and a specific diet for IBD, however, in specific or urgent cases surgery is needed. The most common medicines for IBD treatment include: 

• Immunosuppressants 

Medications are used to regulate the immune system and reduce inflammation by reducing the number of immune cells to calm down the symptoms of the condition. Some of the immunosuppressants for IBD are: azathioprine, mercaptopurine and methotrexate. 

• Steroids 

Steroids are synthetic versions of hormone-like substances that the body naturally produces. They have a powerful anti-inflammatory action and are used to treat IBD flare-ups. The most commonly used steroids for IBD are prednisone and budesonide. Steroids do not stop the symptoms of IBD from reappearing and may cause serious side effects, especially if not dosed properly. 

• Biological medicines 

Biologics are drugs created by genetic engineering from living cells. They target certain enzymes and proteins in your body that contribute to inflammation. Biologics are relatively new as a treatment form and may be an option if immunosuppressants and steroids prove to be ineffective for the case.  

When is surgery for IBD recommended? 

For a long time, surgery for IBD was considered the “last resort”, which has contributed to the negative opinions towards surgical procedures today. According to the Journal of Crohn's and Colitis, in the last decades, gastroenterological practices have improved “Surgeons have subspecialized from general surgeon to colorectal surgeon, and now to even more highly specialized IBD surgeons. The uptake of minimally invasive surgery in combination with enhanced recovery programs has been shown to reduce both complications, and hospital stay. Recovery after surgery to full capacity is now often achieved within 2–4 weeks, thanks to the use of minimal incisions preserving body image, functions, and cosmesis”.  

Surgery recommendations can vary from case to case and must be discussed with a professional doctor, for a better understanding of your individual situation. Surgical treatment for IBD is usually suggested in the following cases: 

• Ineffectiveness of medications  
• Strictures 
• Abscesses or fistulas 
• Retarded growth (in children) 
• Emergency situations 
• Cancer 

Generally, surgery is performed when other treatments prove to be ineffective or due to strictures, abscesses or fistulas. Rarely, the colon can get severely inflamed and form a condition called toxic megacolon, which is more common in UC than Crohn’s patients and requires urgent surgery. 

The types of surgery for IBD 

Surgery is another treatment option for managing IBD and its symptoms, which is usually a good option for more severe cases or emergency situations caused by the illness. The data shows that around 75% of patients with Crohn’s disease and 25% of UC patients require surgery in their lifetime. Surgery for IBD usually can be described as the removal of a part of the colon due to severe inflammation or formed damage to the digestive tract (strictures, abscesses and fistulas). In some cases, the surgery can mean a stoma creation on the abdomen surface and a bag attached for direct extraction of the colon waste from the body. 

There are several different types of surgery that can be used to treat IBD. 

Colectomy 

The most common type of surgery is a colectomy, which is the removal of a part or all of the colon. This type of surgery is often used to treat Ulcerative Colitis, which is a type of IBD. 

Ileostomy 

Other types of surgery that can be used to treat IBD include ileostomy, which is the creation of an opening in the abdomen to allow waste to be collected in a bag. 

Resection 

Resection consists of the surgical connection of the healthy sections of the small or large intestine and removal of the damaged segments. 

Strictureplasty or strictturoplasty 

Reshaping the gut to relieve strictures and obstructions is known as a strictureplasty or strictturoplasty. 

Surgery for fistulas and abscesses 

Fistulas can be treated with resection or by opening them, cleaning them, and then letting them heal. Abscesses may need to be lanced and drained. 

The risks of surgery  

The risks connected with IBD surgery vary depending on the procedure. Infection, bleeding, and intestine damage are typically among the risks of IBD surgery. Fistulas, which are abnormal connections between two organs or between an organ and the skin, also carry a small risk of developing. 

The risk of complications following IBD surgery can increase due to several factors. Age, smoking, obesity, and a history of prior abdominal surgery are a few of these. In addition, some drugs, like steroids, can make complications more likely. 

Overall, IBD treatments should be picked out individually under the doctor’s supervision, to fit each patient’s case. Surgery for the condition treatment is a good option for specific circumstances. Due to innovative methods, now surgery can ease a patient’s life! 

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