Our Summary

This study looked at different surgical approaches to treating Crohn’s disease (CD) in the colon. The goal was to compare the outcomes of three different types of surgeries: subtotal colectomy and ileorectal anastomosis (STC), segmental colectomy (SC), and total proctocolectomy and end ileostomy (TPC). These surgeries involve removing different parts of the colon and rectum.

They found that there was no significant difference between STC and SC in terms of the disease coming back. However, patients who had the STC surgery had a higher risk of CD coming back compared to those who had the TPC surgery.

In terms of complications after surgery, patients who had the SC surgery had a higher risk compared to those who had the STC surgery. On the other hand, STC had a lower risk of complications than TPC.

Lastly, patients who had the SC surgery had a lower risk of needing a permanent stoma (an opening in the body for waste removal) compared to those who had the STC surgery.

In conclusion, all three surgeries were found to be effective treatments for CD in the colon. However, the choice of surgery should depend on the specific situation of the patient, including the extent of their disease. The study suggests that doctors should consider these results when deciding on a treatment plan and explaining the risks to patients.

FAQs

  1. What were the three types of surgeries compared in the study for treating Crohn’s disease in the colon?
  2. Did the study find any significant difference in the risk of the disease returning between the different types of surgeries?
  3. What were the comparative risks of complications and needing a permanent stoma among the different surgeries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about colectomy is to ensure they have a thorough understanding of the different surgical options available and the potential risks and benefits associated with each. It is important for patients to have open and honest discussions with their healthcare team to make an informed decision about the best approach for their individual situation. Additionally, following post-operative care instructions, attending follow-up appointments, and maintaining a healthy lifestyle can help optimize recovery and long-term outcomes after colectomy surgery.

Suitable For

Patients with Crohn’s disease in the colon who have not responded to other treatments, have severe symptoms, or have complications such as strictures, fistulas, or abscesses may be recommended for colectomy. Additionally, patients with ulcerative colitis that is not controlled with medication, have severe symptoms, or have complications such as dysplasia or cancer may also be candidates for colectomy. Patients with familial adenomatous polyposis (FAP) or other hereditary colon cancer syndromes may also undergo colectomy as a preventive measure. Ultimately, the decision to undergo colectomy should be made in collaboration with a healthcare provider based on the individual patient’s specific condition and needs.

Timeline

Before colectomy:

  • Patient is diagnosed with Crohn’s disease in the colon
  • Patient may undergo various treatments such as medications, dietary changes, and lifestyle modifications to manage symptoms
  • If symptoms do not improve or if complications arise, surgery may be recommended as a last resort
  • Patient consults with a surgeon to discuss the different surgical options available

After colectomy:

  • Patient undergoes pre-operative testing and preparation for surgery
  • Colectomy surgery is performed, removing part or all of the colon
  • Patient stays in the hospital for a few days to recover
  • Patient may experience pain, discomfort, and changes in bowel habits post-surgery
  • Patient is monitored closely for any complications such as infection, bleeding, or bowel obstruction
  • Patient is discharged from the hospital and continues to recover at home
  • Patient may need to make dietary and lifestyle adjustments to adapt to life without a colon
  • Follow-up appointments with the surgeon and gastroenterologist are scheduled to monitor progress and adjust treatment as needed

What to Ask Your Doctor

Some questions a patient should ask their doctor about colectomy include:

  1. What are the different surgical approaches for treating my condition, and what are the potential benefits and risks of each?
  2. How will the type of colectomy you recommend affect my quality of life after surgery?
  3. What is the likelihood of my Crohn’s disease coming back after each type of surgery?
  4. What are the potential complications associated with each type of colectomy, and how likely are they to occur?
  5. How long is the recovery process for each type of surgery, and what can I expect during the recovery period?
  6. Will I need a temporary or permanent stoma after surgery, and how will this impact my daily life?
  7. Are there any alternative treatments to colectomy that I should consider?
  8. What is your experience with performing colectomy surgeries, and what is the success rate among your patients?
  9. How will my diet and lifestyle need to change after colectomy, and will I need ongoing medical care or monitoring?
  10. Are there any specific questions or concerns I should discuss with a specialist or additional healthcare provider before making a decision about colectomy?

Reference

Authors: Angriman I, Pirozzolo G, Bardini R, Cavallin F, Castoro C, Scarpa M. Journal: Colorectal Dis. 2017 Aug;19(8):e279-e287. doi: 10.1111/codi.13769. PMID: 28614620