Understanding Surgery in Crohn’s Disease: Risk Factors and Complications

Announcer:
You’re listening to GI Insights on ReachMD. On this episode, we’ll hear about common complications in the postoperative care of Crohn’s disease patients from Dr. Elisa Boden, who’s an Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at Oregon Health & Science University and spoke on the matter at the 2025 Crohn’s & Colitis Congress. Let’s hear from her now.

Dr. Boden:
Crohn’s disease is one of the inflammatory bowel diseases. It’s an immune-related condition that develops in genetically susceptible individuals, and it results in uncontrolled inflammation in the intestinal tract. This can cause symptoms like diarrhea, rectal bleeding, and weight loss, but also, over time, inflammation can result in complications such as strictures—those are narrowings of the colon—or a fistula. Those are connections between the intestine and different organs that can sometimes require surgery over time. Historically, about half of patients with Crohn’s disease have required surgery over the first 10 years after they were diagnosed, but with our new treatments and monitoring, we’ve been able to reduce that by about half in the recent years. But still, many patients require surgery, and unfortunately, some patients require multiple surgeries over time. And almost all patients, after they have surgery, will recur at least microscopically and will require a second surgery over time.

And so some of the risk factors for occurrence of surgery that have been shown to us by older studies are things like smoking—that’s a really important one—young age at onset, history of multiple surgeries, and fistulizing disease. Again, that’s where there’s a connection between the intestine and other part of another organ. And so these are actually incorporated in a lot of our guidelines, but there are some new studies that have suggested some newer risk factors like genetics, the microbiome, and being male and non-White. And so we’re learning more about what these risk factors are over time.

The same kind of complications can happen in Crohn’s disease as with other patients getting surgery, but the major immediate postoperative complications we worry about are things like infections, postoperative leaks, and blood clots. These can actually be more common in Crohn’s patients undergoing a bowel resection because they are commonly malnourished going into surgery. They can also be on medications like steroids that can impact infection and wound healing. And so those are the major things we worry about in the immediate postoperative period.

Announcer:
That was Dr. Elisa Boden discussing complications in the postoperative care of Crohn’s disease patients. To access this and other episodes in our series, visit ReachMD.com slash GI Insights, where you can Be Part of the Knowledge. Thanks for listening!