Why is surgery such a last resort?

[ErikaHouston]

Hi Everyone,
Fairly new to this disease. I am wondering why surgery is always such a last resort for Crohn's? I am now in my 4th hospital stay in 3 months for massive GI hemorrhage (from ulcer in terminal ileum) and just trying to understand why surgery is such a last option. They are switching my drugs again, but I feel like it's only going to be a matter of time before this happens again and I end up back in the hospital. I know Crohn's is not cured by surgery, just trying to understand the real negatives/risks to surgery. I have no other symptoms besides the severe bleeds.
Thanks,
Erika


Diagnosed Oct 2010, on Entocort (not working)...switching to Cimxia in Nov 2010.

 

[Squadinho]

I wouldn't say it is a last resort, I think it depends on the severity of your condition and the doctor you are seeing.

For example, my consultant said to me that surgery for me would be a last resort because practically all of my intestine is involved and it would mean losing a hell of a lot of intestine. He said that if it was just my terminal ilium had been affected as is usual for my age (his words, not mine!) then it would be better for me to have the affected part taken out.

There are then risks that follow surgery such as strictures meaning further ops may well be necessary, and depending on how much you have had out, Short Bowel Syndrome is a possibility.

I guess doctors want to try and give meds the best chance to work because taking out your bowels, because once they're gone they can't come back.

 

[Babs1957]

In general, surgery is serious...all types of complications can result from the anesthesia, blood clots(stroke/heart attacks), internal bleeding, and other things like post-op infections. I believe most docs operate from the viewpoint that the less invasive procedures are preferable until exhausted. Also, insurance companies require that other treatments are attempted before surgery is considered.

I understand how you feel - it's like let's just get the inevitable over with.

 

[Welsh-bird]

Hi Erika,
For me surgery is the last resort. I would rather try every available drug to treat my UC before heading under the knife. I think my time may now have arrived though. Was admitted this morning and am facing a colectomy probably this weekend. I will though, try one last time for my Gastro to allow me Infiximab. As Squadinho has said, once it's gone. it can't be put back (and right now, I really want to keep my colon!). Having been on pred since Feb of this year along with a mixture of other immuno supressive drugs I'm worried about my healing and then recovery. I guess the benefits really do have to outweigh the risks that come with surgery.

 

[tpd320]

U just have to remeber that you only have so much intestine/colon to remove. U coud end up with short bowel syndrome and you do not want that. But for certain folks, surgery has to be done to give you some relief. Also doc told me that surgery is only a temporary fix. It will come back and most likely spread. I can vouch for that. I "had" to have surgery because my intestines periforated due to a very large abscess. Doc told me I should have about 5 years without any symptoms. Well, I flared within two months after having my surgery and it had spread to my colon where it hadn't been before. I don't want surgery again, but I am sure it will be required as some point. I just want to hold off as long as I can to save as much bowel as I can. I still have some years left and will probably need em...

 

[Jer's Girl]

Very good answers so far.

Surgery is also very draining. It effects you for a long time after your scars begin to heal. Sometimes it is the only option left, but I would always rather see if there is an alternative first and avoid all of the pain and emotional issues that accompany surgery.

I know where you are coming from though. Sometimes it just feels like that is where you are headed anyway.

I know that my surgery's were necessary and all of them changed my life for the better. Hope you figure out what is right for you.

 

[cally]

Lots of good posts here! I'll add my two cents:

Surgery (by it's very nature) will cause your intestine to try to heal itself. Sometimes, the intestine can take things too far and heal too much, leading to a great deal of scarring in your bowel at the anastomosis (the juncture where they stitch up your intestines back together after they resect the inflammed portion). This scarring puts you at greater risk for strictures and bowel obstruction, which can be life threatening in a small number of cases.

Another major reason surgery is not preferred with Crohn's disease is that - as others have pointed out - typically Crohn's will almost always flare up at the anastomosis. So, surgery won't cure you - but it can give you a period of remission to help you get on track with medications.

Everyone who has resection surgery has some degree of narrowing due to scarring. When you combine the bowel narrowing with the tendency for Crohn's to flare up at the anastomosis, you can start to appreciate why Crohn's patients often need surgery after surgery to deal with complications that may have been partially set in motion by the first surgery. Many patients who have surgery need another resection surgery within five years.

Once you start down the road of surgeries, you may get to the point where you have had so much bowel taken out that you do not have enough bowel left to connect back to the rectum. In these cases, patients will receive ostomies. For this procedure, an opening is created on your abdomen and connected to your remaining bowel. With an ostomy, you need to wear a plastic pouch to collect fecal waste. Even in patients who never get to the point of needing an ostomy, some will experience 'short bowel syndrome,' which results in malnutrition (an inability to absorb enough nutrients due to the reduced length of bowel) and often involves chronic diarrhea.

In my understanding, surgery is generally reserved for patients who have literally tried and failed to respond to all medicines currently available for CD, or for patients who have severe complications (such as abscesses, severe strictures, fistulae that do not respond to antibiotics, etc.). I know my post sounds very doom and gloom - many people have surgery and do VERY well with it. But it is important to be aware of the potential risks and complications.

 

[ErikaHouston]

Thanks for all the replies, very insightful. My overall conculusion: this disease SUCKS:ysmile:!

 

[Jer's Girl]

Ha ha! Ya think?