When is the right time to have surgery?

[JMC]

I had a flare up while on holiday in July during which I suffered severe cramping and vomiting and probably had a temporary obstruction. I was referred for a MRI scan and the results showed (from my doctor's notes):

"His MRI scans shows active inflammatory bowel disease and stricturing of the terminal ileum and sigmoid colon. There is also evidence of enteroenteric and enterocolic fistulation."

After a two month course of antibiotics (ciprofloxacin and metronidazol) and restarting 150mg/pd of azathioprine I saw my consultant again today and he has referred me to a surgeon. At this stage, this is just to weigh up the options and get an opinion, but my consultant has told me that medication often does not resolve the sort of problems I am suffering with.

Right now though, I am not keen on the idea of surgery. I have had surgery in the past on a perianal fistula, but that was not as daunting as a resection. I am not suffering any pain, I work every day and my symptoms at the moment are mostly loose/watery stools and fatigue, particularly in the afternoon following lunch.

If I knew surgery was a "quick fix" and all of my symptoms would go away, I would consider it, but I also know surgery is not a cure and I fear this is just the slippery slope to having more and more of my intestine chopped out!

Then again, should I do it now, while I am relatively well? How long does it generally take to recover? How big are the incisions, will I be opened up or is it key hole?

I really appreciate any advice you can give me as this has been a bit of a setback for me today.

 

[doctor's mom]

One thing I know for sure is to do a surgery when you prep for it in advance with meds and feeling strong enough, just like you are now. Probably your doc suggested a surgery because of fistulas.
Usually, normal recovery time after so called basic resection 2-3 weeks. I think now they do it laparoscopicly in some cases. Please guys, correct me if I am wrong.

 

[archie]

Hi I had the same debate last year I had been poorly with an abscess then with the pred etc to treat it i was feeling relatively well again. All along the surgeons said I would need surgery to remove 1ft of small intestine and a bit of large. It was a battle but the surgeon won and since the resection I feel much better so he was right. It took 5 weeks to recover I have about a 5 cm incision through my belly button and a few keyhole scars but nothing drastic. I'm off all meds which is bliss. Have the occasional bad day tummy wise but recent scopes show no active crohns. My advice is if you definitely need surgery elective is best when your feeling good rather than an emergency. It was the right decision for me. Good luck whatever you decide to do and if you've any other questions re surgery just ask.

 

[DustyKat]

I have had both my children go through resections, one planned and one emergency, and planned surgery is without a doubt the preferred method. Recovery time is better, there is less chance of unplanned outcomes and of course you are generally in a better physical and psychological state.

My son recently had surgery due to fistula's originating in the terminal ileum and we were told that fistula's in this area will not respond to closure by medication.
Pre operatively my son's physical condition continued to decline despite medication but now, 5 months post op, he hasn't looked so well in I don't when.

Matt had complications of abscesses also being present, plus some other unknown problems, so laparoscopic surgery wasn't possible. Even so, after open surgery he was home in 8 days, driving short distances in 3 weeks and going to soccer training after 5 weeks. I noticed the biggest leap forward both in his physical abilities and mood was at the commencement of week 4 post op.

Dusty. xxx

 

[Misty-Eyed]

I was/am in the same position as you when it came to deciding to have surgery. I have bad strictures in my colon which I've had for a good few years but now there is no more medication I can take to make them better. Saying that, I'm feeling more well that I ever have. I finished my degree last year, now have a full time job that I love, go running and will quite happily stay out of the house all day without worrying about wanting to go to the toilet. So you can imagine my dismay when they tell me they want to take my entire colon out and leave me with a bag forever!

Back in the day, I used to have the same concerns as you when it came to surgery.. it should be a last resort.. what if they take the diseased part out and it comes back somewhere else and I end up with hardly any intestines left! I feel great, why have it done now?

Well in Feb I ended up in hospital as an emergency with an obstruction. The thought of having the op done as an emergency terrified me and made me realise that I do need the surgery. I'd rather have it done when I can mentally prepare myself and when I'll be able to recover faster than have it done as an emergency. So now I'm having it done next week.

Luckily you're not facing a permanent bag like me, but I know that strictures end up turning into scar tissue which cause so many problems that it may be worth having a resection. I'm having mine done via keyhole and will end up only having little round scars despite the enormity of the operation. I'm at St Marks in Harrow where they always do keyhole if it's possible. Good luck with whatever you decide!