Ileal Resection for Crohn’s Disease: A Patient’s Guide

Introduction and Terminology of the Procedure

An ileal resection is a surgical procedure typically used to treat severe forms of Crohn’s disease, a chronic inflammatory bowel disease. During this procedure, a segment of the ileum, the final part of your small intestine, is removed due to damage or disease. The remaining healthy parts of the intestine are then reconnected to allow normal function. This operation can significantly improve your quality of life, especially if your Crohn’s disease has become unresponsive to medication.

In the USA, roughly 20% to 40% of people with Crohn’s disease will require some form of surgery, like ileal resection, during their lifetime. This procedure, though less common than medication-based treatments, is a well-established option for individuals with more serious complications. The terminology you should be familiar with includes ‘laparoscopy’ (a less invasive surgical technique), ‘anastomosis’ (the reconnection of healthy intestine parts), and ‘endoscopy’ (a diagnostic procedure to examine your digestive tract).

Indications for Ileal Resection

Ileal resection isn’t the first line of treatment for Crohn’s disease. It’s typically reserved for specific situations and complications where conservative treatments have failed. Here are some of the indications for considering an ileal resection:

• Medication Resistant Disease: When symptoms persist despite optimized medical therapy, surgery may be considered to provide relief.
• Intestinal Obstruction: Scar tissue from repeated inflammation can cause the intestine to narrow, leading to obstruction. If medications don’t alleviate this, an ileal resection can be beneficial.
• Fistulas or Abscesses: These abnormal connections or collections of infected fluid can occur between different parts of the intestine or between the intestine and other organs. They often require surgical intervention if they don’t respond to medication.
• Perforation: A hole or tear in the intestine can lead to severe complications, including sepsis. Immediate surgical intervention is usually required in these cases.
• Bleeding: In rare cases, Crohn’s disease can lead to significant bleeding that may necessitate surgery.
• Cancer: Though rare, Crohn’s disease can increase the risk of the small intestine or colon cancer. If detected, surgical removal may be necessary.

Each case is unique, so discussing your options with your healthcare provider is essential to determine the most effective treatment for you.

Pre-Op Preparation

Preparing for an ileal resection requires specific pre-operative steps. Your healthcare provider will guide you through the process, which may include:

• Fasting for a certain period before surgery.
• Adjusting or temporarily discontinuing certain medications.
• Completing necessary pre-op labs or imaging.
• Obtaining pre-clearance authorization.
• Arranging transportation for the day of the surgery.
• Obtaining necessary work or school notes.

Note that this is a general guideline and the specific instructions can vary based on individual circumstances. Always follow your doctor’s advice. For instance, discuss with them any medications you are currently taking that may need to be stopped before the procedure and when they should be resumed afterward.

If you require help with pre-operative clearances and ordering of pre-op labs and imaging, our telemedicine primary care practice can assist you. Feel free to reach out to us at any time for this service and further guidance.

Procedure Technique for Ileal Resection

Understanding the ileal resection procedure can make you feel more prepared and less anxious about your upcoming surgery. Here, we outline the step-by-step technique for ileal resection, simplifying medical jargon to enhance your understanding.

Preparation

Before the surgery, you’ll be given anesthesia to ensure you’re asleep and pain-free throughout the procedure. You’ll also have a urinary catheter inserted to collect urine and an intravenous (IV) line established to provide fluids and medications.

Initiating the Procedure

The procedure can be performed as an open surgery or laparoscopically, which is less invasive. The surgeon makes a large incision in open surgery, whereas several small incisions are made in a laparoscopic procedure. This decision depends on your condition and your surgeon’s judgment.

Identifying the Diseased Section

The surgeon will then carefully inspect your small intestine, particularly the ileum, to identify the diseased section that needs to be removed. Special instruments are used in laparoscopic procedures to magnify the view of the surgical area.

Removing the Diseased Section

Once the diseased segment is identified, the surgeon will carefully cut it out, ensuring to preserve as much healthy tissue as possible. This procedure is termed as ‘resection.’

Anastomosis

Following the resection, the surgeon will reconnect the remaining healthy parts of your intestine in a process called ‘anastomosis.’ This ensures the continuity of your digestive tract. The surgeon may use sutures or special surgical staples for this connection.

Checking for Complications

The surgeon will then inspect the surgical area to check for any signs of bleeding or leakage from the new connection. They might test the integrity of the anastomosis by injecting air or dye into the intestine and watching for leaks. If there are any issues, they will be addressed immediately.

Closing the Incisions

Once the surgeon is satisfied that the anastomosis is secure and there are no complications, the incisions will be closed. If you had a laparoscopic surgery, the small incisions will be stitched up and covered with dressings. In case of open surgery, the larger incision will be closed with sutures or staples.

Recovery Room

After the surgery, you’ll be moved to a recovery room where your vital signs will be monitored as you wake up from the anesthesia. You may feel groggy and a bit uncomfortable, but the healthcare team will provide medications to manage any discomfort.

The ileal resection procedure is a well-established surgery with skilled surgeons and healthcare teams ensuring you’re in good hands. Remember, it’s normal to feel anxious before surgery, but understanding the procedure can help you feel more prepared and reassured. Do not hesitate to discuss any concerns with your healthcare provider.

Duration of Ileal Resection

The ileal resection procedure typically lasts between 1 to 3 hours. However, the exact duration may vary depending on the complexity of your case and whether the procedure is being performed laparoscopically or via an open surgery.

Post-Op Recovery from Ileal Resection

Post-operative recovery varies among patients. After surgery, you’ll typically spend 2 to 5 days in the hospital. This time allows your healthcare team to manage your pain, monitor for complications, and ensure your digestive system is functioning properly.

Upon discharge, a follow-up appointment will be scheduled with your surgeon within 2 weeks. Rehabilitation or physical therapy is usually not necessary, but you’ll need to make lifestyle changes like adopting a healthy diet and gradually resuming physical activities.

Most patients can return to work after 2 to 4 weeks, but this depends on the nature of your job and your recovery progress. Full recovery usually takes about 6 to 8 weeks. However, everyone’s recovery timeline is different, and your doctor will provide personalized guidance.

Remember, our primary care practice is here to support you throughout your recovery journey. We’re available until 9 pm on weekdays and 5 pm on weekends to provide necessary work or school notes, so feel free to reach out.

Effectiveness of Ileal Resection

The ileal resection procedure has proven to be highly effective in treating Crohn’s disease. Statistics show that up to 70% of patients find relief from symptoms after surgery. However, it’s important to note that Crohn’s disease is a chronic condition and may recur over time.

The procedure’s effectiveness can be influenced by various factors. A successful ileal resection often results in an improved quality of life and reduced dependency on medications, particularly in patients with complications like intestinal obstruction, fistulas, or abscesses.

However, certain circumstances may reduce the procedure’s effectiveness. Crohn’s disease can recur in different parts of the digestive tract. Risk factors for recurrence include smoking, a previous history of Crohn’s disease surgeries, and certain genetic markers.

Maintaining a good relationship with your healthcare provider, adhering to prescribed medications, and adopting lifestyle modifications such as smoking cessation and a balanced diet can help manage the disease and improve the effectiveness of the procedure.

It’s important to remember that while ileal resection can provide significant symptom relief, it’s not a cure for Crohn’s disease. The goal is to improve your quality of life and manage the condition effectively.

Adverse Events with Ileal Resection

Like any surgical procedure, ileal resection carries certain risks. Potential adverse events include:

• Postoperative infection (10-15%): This can occur at the surgical site or internally within the abdomen. It is usually caused by bacteria and typically manifests with symptoms such as fever, redness, swelling, and increased pain.
• Deep vein thrombosis (2-5%): This is a blood clot that forms in a deep vein, often in the leg. It can cause pain and swelling and can be serious if the clot travels to the lungs.
• Internal bleeding (3-8%): This can occur if a blood vessel is inadvertently damaged during surgery. It can result in pain, and a drop in blood pressure, and requires immediate attention.
• Anastomotic leak (1-3%): This is a leak from the site where the intestine is rejoined. It can cause infection and sepsis and usually requires further surgery.
• Short bowel syndrome (<1%): This rare condition occurs when a large portion of the small intestine is removed, impairing nutrient absorption.

The overall mortality rate for ileal resection is less than 1%, making it a relatively safe procedure given its complexity.

Alternatives to Ileal Resection

If you’re considering alternatives to ileal resection, there are several options available. Medications such as anti-inflammatories, corticosteroids, immunosuppressants, and biologics are often the first line of treatment for Crohn’s disease. If medications aren’t effective, other surgical procedures such as stricturoplasty or bowel resection can be considered. Moreover, lifestyle modifications, including dietary changes, smoking cessation, and stress management, can complement other treatments to manage symptoms.

Experimental or Emerging Technologies

Research on novel therapies for Crohn’s disease is ongoing. One promising area of research is fecal microbiota transplantation (FMT), which involves transplanting healthy gut bacteria into patients with Crohn’s disease to restore a balanced intestinal microbiome. Additionally, researchers are exploring the potential of stem cell therapy to reduce inflammation and promote the healing of damaged tissues in the gut.

Conclusion

Understanding your condition and the available treatment options is an important step in managing Crohn’s disease. Ileal resection is an effective surgical procedure with a good safety profile, but it’s not without risks. Other treatments, including medications, other surgical procedures, and lifestyle modifications, can also be effective. Emerging therapies like FMT and stem cell therapy are under investigation. Always consult with your healthcare provider to determine the best course of treatment for you.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.