None — Crohn's Disease
Crohn's disease in a type of inflammatory bowel disease. It can involve any area of the digestive tract, from the mouth to the anus, but most commonly affects the last area of the small intestine, called the ileum. The inflammation usually runs deep into all layers of the intestine, causing swelling, stomach cramps and pain. Other symptoms can include persistent diarrhea, rectal bleeding, weight loss, fever, joint pain, irritation of the skin or eyes, anemia and, in children, growth problems.
The Crohn's and Colitis Foundation of America estimates about 500,000 Americans have Crohn's disease. Men and women are affected equally. The condition is usually diagnosed between 20 and 30. Roughly 10 percent of patients are under 18. The cause isn't known. However, researchers believe the disease may occur from a combination of genetic susceptibility, immune reaction and environmental exposures.
Surgery for Complications
The most common complication of Crohn's disease is blockage of the intestines caused by scar formation and thickening of the intestinal wall. The disease can also cause ulcers that erode through the tissues, creating an artificial tunnel (fistula) between two organs, like the bladder, vagina and skin. Small tears can also develop in the lining of the intestines.
Medications can often control the symptoms of Crohn's disease for some time. Eventually, up to 75 percent of patients will require surgery to correct complications that can't be effectively treated with drugs. Surgery is also needed if patients develop blockages, perforation, infection or serious bleeding in the intestines. The goal of surgery is to remove the diseased section of the intestines and connect the two healthy ends.
Surgery isn't a cure for Crohn's disease and the symptoms often return because the disease often recurs in other portions of the intestinal tract. Researchers estimate that about half of all surgery patients experience recurrence of symptoms within ten years.
Belly Button Access
While surgery is typically successful in temporarily relieving symptoms of Crohn's disease, patients still experience a significant amount of pain and recovery after the procedure. Some physicians perform the surgery laparoscopically, using several small incisions and tiny surgical instruments. The smaller incisions generally mean less post-operative pain and a shorter recovery time. However, even laparoscopic surgery leaves behind small scars from the incisions.
Now, there's another technique called single incision laparoscopy (SILs). Instead of making four or five small incisions (the traditional number for laparoscopy), doctors use one incision and go through the belly button. Once the cut is made, a small port is placed through the incision. The port stretches and holds the opening, giving surgeons a bigger opening through which to work. Flexible surgical instruments, designed specifically for SILs surgery enable the physician to see inside the abdomen from all angles.
For Crohn's surgery, the physician locates the target portion of the colon and cuts the two ends of the diseased segment. That portion is then pulled out through the opening in the belly button. Next, the surgeon pulls the two healthy ends of the colon together, and then secures them with sutures. T.J. Swope, M.D., Laparoscopic Surgeon with Mercy Medical Center in Baltimore, MD also uses an hourglass-shaped device to temporarily cover the abdominal wall during the surgery. This will prevent infection or possible cancer cells from contaminating and spreading disease when the diseased tissue is pulled through the belly button incision.
Swope says the single-incision surgery is being used for several different types of procedures, including gallbladder removal, appendectomy, colostomy, stomach resection, weight loss surgery, stomach tumors, adrenal gland removal and anti-reflux surgery. Since SILs is still a relatively new technique, patients should look for a surgeon who has experience with the procedure.
For general information about Crohn's disease:
American Society of Colon and Rectal Surgeons Crohn's and Colitis Foundation of America National Institute of Diabetes and Digestive and Kidney Diseases