By Ritha Belizaire, MD, FACS, FASCRS | Board-Certified General and Colorectal Surgeon

Quick Insights

Crohn's disease is a lifelong inflammatory bowel disease that can affect any part of the digestive tract. Medicine is the main treatment, but many people with Crohn's will need surgery at some point. Surgery doesn't cure Crohn's. Done well and timed right, it can relieve a blockage, treat a fistula or abscess, and get you off steroids and back to your life.

Key Takeaways

• Surgery is considered when medicine isn't working, causes side effects, or when complications like strictures, abscesses, or fistulas develop.
• The goal is to remove or open only the diseased segment and save as much bowel as possible.
• Minimally invasive (laparoscopic or robotic) surgery is preferred when it's safe.
• Staying on Crohn's medicine after surgery and stopping smoking both lower the chance of the disease coming back.

When Is Surgery Needed for Crohn's Disease?

Guidelines from the American Society of Colon and Rectal Surgeons (ASCRS) recommend considering surgery when:

• Medicines aren't controlling the disease, or their side effects are too much
• You can't come off steroids
• A narrowed segment of bowel (stricture) causes blockages and can't be stretched with a scope
• An abscess or fistula develops
• There are precancerous changes (dysplasia) or cancer
• Severe colitis doesn't respond to treatment, or there are signs of a perforation

Research shows the need for surgery in Crohn's has dropped over the past several decades as medicines have improved. But surgery is not a failure. For the right patient, at the right time, it can be the fastest path to feeling well.

Types of Crohn's Surgery

• Bowel resection: the diseased segment is removed and the healthy ends are joined. The most common operation is an ileocolic resection, which removes the end of the small intestine and the start of the colon. I often perform these robotically through small incisions.
• Strictureplasty: a narrowed segment is opened up and reshaped without removing it. This saves bowel length, which matters for people who may need more surgery in the future.
• Colectomy: when Crohn's mainly affects the colon, part or all of the colon may be removed.
• Temporary ostomy: sometimes a temporary ileostomy protects a new connection while it heals, especially if you've been on high-dose steroids or are malnourished.

Perianal Crohn's Disease

About 1 in 4 people with Crohn's develop problems around the anus, such as abscesses and fistulas. These are treated with a combination of a seton (a soft drain), sometimes a repair, and medical therapy. See my anal fistula page for more detail.

Getting Ready for Surgery

I partner with your gastroenterologist to get you as healthy as possible before an operation. That may include:

• Lowering or stopping steroids, which raise the risk of infection after surgery
• Improving nutrition, sometimes with special shakes or IV nutrition
• Draining an abscess first, then operating once the infection has calmed
• Stopping smoking, which strongly increases the chance of Crohn's coming back

After Surgery

Crohn's can return near where the bowel was joined. That's why the plan after surgery matters as much as the operation. Most patients restart or adjust Crohn's medicine with their GI doctor, and a colonoscopy is usually done within about 6 to 12 months to check for early signs of recurrence.

Crohn's or Endometriosis?

Bowel endometriosis can cause cramping, bleeding, and bowel changes that look a lot like Crohn's disease, and the two are sometimes confused. If you've been told you have Crohn's but your symptoms flare with your period, read my article on bowel endometriosis vs. Crohn's disease.

Schedule a Consultation

If you're dealing with any of these symptoms, you don't have to wait. Call my Houston office at 832-979-5670 to request a same-day or next-day appointment. My office is at 427 W. 20th Street, Suite 710, in Houston Heights, and I operate at several hospitals across Houston.

Medical Disclaimer

This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always talk with your physician about your own situation.

Frequently Asked Questions

Will surgery cure my Crohn's disease?

No. Surgery treats complications and diseased segments, but Crohn's is a chronic disease and can come back elsewhere. Medicine after surgery and not smoking lower that risk.

Will I need an ostomy?

Most Crohn's operations don't require a permanent ostomy. A temporary ostomy is sometimes used to protect healing bowel. We'll talk about this before surgery so there are no surprises.

How long is recovery after Crohn's surgery?

With minimally invasive surgery, most patients stay in the hospital a few days and return to most normal activities within about 4 to 6 weeks.

Do I still need my gastroenterologist after surgery?

Yes. Crohn's care is a team effort. I work with your GI doctor before and after surgery.