The main treatment of Crohn’s disease is various drugs that suppress the immune system. Therefore, gastroenterologists follow up and treat patients with Crohn’s disease. However, 80% of patients with Crohn’s disease need surgery at some point in their lives.Unfortunately, it is very difficult to find a surgeon experienced in this disease in our country, and gastroenterologists stuck at this stage of the treatment since they often have difficulty in finding a competent surgeon. The task of a gastrointestinal surgeon is to entirely bridge this gap. Assoc. Prof. Samet Yardimci, MD received training in inflammatory bowel disease surgeries during his subspecialty training of gastrointestinal surgery and then played an active role in the establishment of inflammatory bowel diseases unit at Marmara University and operated more than 200 patients with inflammatory bowel disease during a 5 year period.
Two groups of patients with Crohn’s disease require two completely different surgeries:
- Conditions requiring intestinal surgery: The intestine involved as a result of recurrent inflammatory attacks becomes dysfunctional after a while. This causes obstruction in some patients, resulting in unbearable cramp-like abdominal pain, while it manifests itself with vomiting and weight loss in some patients, making the patient’s life unbearable with diarrhea and constipation episodes. The majority of the patients become reluctant to eat since they are afraid of pain. In some patients, intraabdominal abscesses and infections make the situation even more difficult. In such a case, the removal of the intestinal segment affected by the disease relieves this condition.
- Perianal Fistula: The second most commonly involved region in Crohn’s disease is the rectal region. Patients complain of rectal pain that affects patient’s life very negatively due to fistulas and resulting recurrent abscesses in the rectal region, persistent discharges, and infections with fever. The fact that Crohn’s treatment cannot be administered due to infections aggravates the disease even more and further complicates the situation.
At this point, seton stitch provides great relief in the vast majority of patients. By this mean, patients can live a much more comfortable life, get rid of abscesses and comfortably receive other treatments.
It is important to remember that the actual treatment of Crohn’s disease is not surgery and that Crohn’s disease continues after the surgery. Surgery aims to reverse the disease to the day it started in some way. Drug therapies should continue after the surgery. Therefore, the follow-up of gastroenterologist come into prominence at this point.
Why is surgery for Crohn’s disease more risky than other surgeries?
The drugs used to control Crohn’s disease are immunosuppressive drugs. Naturally, patients using these drugs are more susceptible to various infections (microbial diseases). In the postoperative period, both surgical site infections and infections of another region other than the surgical site (such as the lung or urinary tract) are more common.Moreover, some patients may develop vitamin, mineral and protein deficiencies due to malnutrition since the digestive tract does not properly function, making the patient devoid of basics required for healing in the postoperative period. Even if the surgeon performs an excellent surgery, the outcome may not be successful if the patient’s healing function is impaired. Therefore, the timing of surgery is of great importance.
What can be done to reduce the risk?
The timing of surgery for Crohn’s disease is very important for the success of the surgery. Immunosuppressive drugs should be eliminated by the patient’s body as much as possible. For this reason, the surgeon should know the mechanism of action and duration of action of all these drugs and act accordingly. Moreover, in some cases, the nutritional status of the patient may need to be improved. For this purpose, intravenous or oral disease-specific nutritional supplements should be used. The surgeon should be capable of performing any surgery that may be required in Crohn’s disease and be prepared for all conditions and should probably be in contact with the gastroenterologist, who knows the patient for years.