How much do you know about surgical treatment of inflammatory bowel disease?

Author: Fan Xueshun, Chief Physician of China-Japan Friendship Hospital

Reviewer: Lin Guole, Chief Physician, Peking Union Medical College Hospital

Inflammatory bowel disease will recur. Generally speaking, during an acute attack, it will cause congestion, erosion, ulceration, and edema. When it is not an attack, the inflammation or ulceration will be alleviated and the local color will become lighter.

As it recurs, the patient's intestinal mucosa repairs and proliferates itself, resulting in pseudopolyps, intestinal stenosis, intestinal obstruction, etc. Some reports have confirmed that long-term inflammatory bowel disease has the risk of cancer.

Therefore, the treatment of inflammatory bowel disease is very important, and some patients need surgical treatment.

1. Which patients with inflammatory bowel disease require surgical treatment?

Generally speaking, after intensive medication treatment, there is no effect at all. The patient has repeated symptoms and all conditions are very bad, such as frequent anemia and weight loss. The patient can no longer tolerate it, and surgical treatment should be considered at this time.

The second is that it affects the normal development of adolescent patients. For example, if the effect of the medicine is not good after the teenagers have taken it and the child’s growth and development is also affected, surgery should be considered.

The third is that when complications suddenly occur, such as intestinal obstruction, perforation, heavy bleeding, or even cancer, surgery should be considered.

Surgery is also a basic method for treating inflammatory bowel disease (ulcerative colitis, Crohn's disease), and its approach is different from that of internal medicine.

Internal medicine generally advocates conservative treatment, but surgery believes that long-term treatment has no good effect, so it is better to simply cut off the diseased intestine.

Figure 1 Original copyright image, no permission to reprint

2. What are the risks of surgical treatment for inflammatory bowel disease?

The main risk of surgery is recurrence.

Because at present, whether it is ulcerative colitis or Crohn's disease, the five-year recurrence rate in China is about 12%, and the five-year recurrence rate abroad is about 30%, so inflammatory bowel disease has a certain probability of recurrence.

Why does it relapse?

For example, in the case of ulcerative colitis, surgery should be to remove the entire colorectum. If it is completely removed, the patient can recover. However, in some cases, whether for objective or subjective reasons, the doctor does not remove the entire colorectum, leaving part of the rectum. The remaining part of the rectum may often recur, and a second surgery is required.

Therefore, the main risk of surgery is the high risk of recurrence, which is something that needs to be paid attention to in clinical practice.

Figure 2 Original copyright image, no permission to reprint

3. How should patients with inflammatory bowel disease eat and exercise after surgery?

Diet is very important after surgery for inflammatory bowel disease, and recovery is generally slow. For example, right after surgery, liquid food, semi-liquid food, and low-residue food are the main foods.

First, you should eat small and frequent meals, starting with liquid food. Once your gastrointestinal function has gradually recovered, you can switch to a semi-liquid food, and then to a normal diet. This requires a process.

The second is that the patient must have self-confidence. Since the surgery has been done, he should think that his disease has been cured. He should not have fear or burden and should slowly restore his self-confidence. Self-confidence is very helpful in overcoming various diseases because human spiritual strength is very strong.

The third is to exercise properly, which is good for the recovery of the body. When exercising, it is recommended not to walk vigorously, because walking too fast or too much will promote the excitement of the parasympathetic nerves and cause more bowel movements. At the same time, you cannot climb heights or stairs, because too much activity will affect gastrointestinal function and peristalsis.

You can also do anal lifting exercises and deep breathing. When lifting the anus, you can regulate your breath and make the blood circulation of the human body. With each breath, the anus lifting can exercise your spirit and spirit, which is also good for overall recovery.