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Ileocaecal resection surgery for Crohn’s disease

Ileocaecal resection removes the terminal ileum and the caecum when they have been damaged by Crohn's disease.

What forms of Crohn's disease is ileocaecal resection surgery used to treat?

Ileocolitis - the most common type of Crohn’s disease which affects the end of the small intestine (known as the ileum) and the colon (large intestine) - most often on the right side.

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Why is ileocaecal resection surgery needed for Crohn's disease?

Ileocaecal resection removes the terminal ileum (the last part of the small intestine) and the caecum (the first part of the colon which connects the small and large intestines together). The healthy ends of the small intestine and the large intestine are then directly joined together. This surgery is often needed when these sections become severely damaged by Crohn’s disease. This can often result in strictures (a narrowing) of the bowel or blockages. If the strictures are long then resection surgery can be needed to remove the damaged sections. Inflammation may also cause other damage which requires them to be removed. People also have surgery if they have failed to respond to medication to help control their Crohn’s disease.

How is ileocaecal resection surgery done?

In preparation for the surgery you may be required to eat a certain diet or take certain medications or supplements to prepare your bowels. Each hospital and surgeon is different in what they require patients to do - but, for example, you may be asked to eat a low residue diet for a few days prior to your surgery and take some laxatives. Make sure you find out from your surgeon if there are any things you should/shouldn’t do to help prepare you for your operation.

Ileocaecal resection can be carried out either as open surgery or laparoscopic (keyhole) surgery.

Open surgery: You will probably be given a general anaesthetic while the operation is carried out. A catheter will be placed into your bladder to drain away urine. The surgeon will shave your abdomen and clean and prepare it using and iodine or alcohol-based cleaner. The surgeon will then make an incision in your abdomen to create an opening through which the surgery will be carried out. The terminal ileum and the caecum will be located, examined and then removed. The healthy end of the small intestine will then be attached to the healthy end of the large intestine either by staples or by being handsewn. This join is called the anastomosis.

Laparoscopic surgery: The preparation for laparoscopic surgery is similar to the open surgery above. However, instead of making one larger incision the surgeon will make several smaller incisions (or ports) through which they will work. They will use cameras, inserted through these incisions, to see what they are doing and will insert the surgical instruments and carry out the surgery through these incisions too.

In general, laparoscopic surgery results in a quicker recovery time and small scars. Sometimes, during the procedure, the surgeon discovers that it is not safe to carry out the ileocaecal resection using this technique and may have to do it through open surgery instead.

Recovering from ileocaecal resection surgery

After the surgery you will probably still have a catheter in your bladder for a short time and you may also have an intravenous drip to give you fluid until you are able to drink normally again and you may also have pain medication.

Many people are encouraged to eat as soon as they feel able after the operation and are encouraged to move around too.

Generally you will need to stay in hospital for 2-5 days after laparoscopic surgery and 5-7 days for open surgery, though this can vary greatly.

After discharge from hospital you will be asked to keep mobile (moving) and avoid heavy lifting and increased physical activities for around 6 weeks. Some patients are able to begin driving again after 2 weeks, but this can vary greatly depending on the operation and the patient.

Possible complications of ileocaecal resection surgery

  • There are risks associated with any abdominal operation and you should discuss the risks specific to you with your surgeon before the operation
  • Wound infections can occur at the incision sites - in both open and laparoscopic surgery. These may require antibiotics to be treated
  • Sometimes the bowel may take longer than normal to start working - this is known as ileus and can cause abdominal swelling and vomiting. This can be caused by a kink, twist or adhesion causing a blockage. In some cases this settles naturally but sometimes a further operation is needed
  • Occasionally the join (anastomosis) between the two healthy sections of the bowel can leak. This is known as an anastomotic leak. In some cases further surgery is required to fix the leak while in others draining of the fluid from the leak can allow the anastomosis an opportunity to heal properly
  • There is a risk of developing abscesses and fistulas

Things to know about ileocaecal resection surgery

  • This is a common type of surgery used to treat strictures/blockages or damaged areas of small intestine as a result of Crohn’s disease
  • Many people with Crohn's who have resection surgery do have an improved quality of life
  • Some patients who undergo bowel resection will have a recurrence of the Crohn’s disease at the anastomosis (where the healthy ends of the bowel are rejoined)
  • You can also be at risk of a vitamin B12 deficiency as the ileum is responsible for absorbing B12 from the food you eat
  • Having your ileum removed can put you at risk of bile acid malabsorption. This can cause chronic diarrhoea

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