Inflammatory Bowel Disease
Crohn’s disease / Ulcerative colitis
One focus of our Visceral Centre is the treatment of chronic inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Our surgical department therefore performs all operations necessary to assure the containment and management of acute and chronic complications.
Surgery is required with
- severe narrowing of the intestine or bowel obstruction (ileus)
- occurrence of abscesses
- formation of fistulae
- severe haemorrhage
- ulcerative colitis with risk of cancer development
Strictureplasty and partial bowel removal
As a result of the inflammation associated with Crohn’s disease, narrowing (stenosis) of the small intestine frequently occurs.
Since nutrient absorption takes place in the small intestine, any surgical procedure must aim to preserve as much of the intestine as possible. With short bowel strictures, a strictureplasty is performed where the bowel is widened by making a lengthwise cut and then sutured crosswise, so that the stenosis is expanded without any of the bowel needing to be removed.
Longer strictures or extensive inflammation may require partial bowel removal (bowel resection), which is always undertaken as sparingly as possible. The inflammation / stricture is most commonly found at the junction between the small and large intestine (transition from the ileum to the caecum), so that ileocaecal resection is performed.
These operations are routinely done using minimally invasive surgery (MIS).
Surgery with abscesses / fistulae
Fistulae and abscesses of the rectum are further complications of Crohn’s disease that require timely surgical treatment to avoid damage to the anal sphincter. In addition to treatment of abscesses, placement of a seton or a fistulotomy, we also perform fistula closures using plugs or advancement flaps in the case of complex fistulae involving the sphincter.
In rare cases, with pronounced fistulae and inflammation, an ileostomy may become necessary. After healing of the inflammation / fistula is complete, the stoma is reversed.
Proctocolectomy
With ulcerative colitis in particular, the illness may be so severe with inflammation of the entire colon (toxic megacolon), that it cannot be treated with drugs. Surgical removal of the colon (colectomy) with creation of a stoma may therefore be necessary.
Ulcerative colitis can also increase the risk of developing colon cancer over time (40% risk of cancer after 25 years of living with the disease), so that many patients with cancer or precancerous stages may need to undergo removal of the colon and rectum (proctocolectomy). This operation is also performed using minimally invasive surgery.
