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Originally published October 6, 2026
Last updated October 6, 2026
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Advanced medical therapies have all but revolutionized how physicians care for patients with inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis. And that’s shifted when — and for whom — surgery fits into IBD treatment.
As Kyle Cologne, MD, a colorectal surgeon with the USC Colorectal Surgery Program, part of Keck Medicine of USC, observes, “Back when patients had one or two medical options and didn’t respond to either, they were left with surgery. Now, people are responding to new medical therapies in ways they haven’t before, decreasing how many need traditional surgery, particularly for ulcerative colitis.”
Anti-interleukin therapies and small-molecule drugs like sphingosine-1-phosphate (S1P) receptor modulators and janus kinase (JAK) inhibitors have proven so effective since their widespread adoption that the five-year probability of surgery has tumbled from 30.1% to 13.9% for patients with Crohn’s disease and from 16.2% to 5.8% for those with ulcerative colitis.
Paradoxically, though, these drugs’ effectiveness has had a “weeding out” effect on the pool of surgical candidates.
As Cologne explains, “Patients want to try as many medical options as they can. But if they get to option X and it doesn’t work, it’s time for surgery. And by that point, the patient’s further down the line of illness, and surgery becomes more complicated.”
The good news at Keck Medicine, Cologne says, is that “we’re used to complicated surgeries and have good outcomes with them.”
For example, Kono-S anastomosis — a hand-sewn intestinal-reconnection procedure — effectively lowers surgical recurrence rates in patients with Crohn’s disease. “It’s a technique that almost excludes the mesentery, which is where we think a lot of the inflammatory reactions happen,” Cologne says.
Sophisticated imaging is also helping surgeons “personalize” treatment. “With Crohn’s disease, for example, you need to know what the problem is before fixing it,” Cologne notes. “In a complicated case where the patient’s had three prior surgeries, performing the right imaging to get a roadmap of where and how to operate is more important than it is with a patient who hasn’t had surgery yet.”
Keck Medicine doctors are also pioneering the use of autologous stem cells in treating Crohn’s disease, particularly in cases of perianal disease and fistulas.
“Stem cells injected into this area work via a dual mechanism,” Cologne explains. “The stem cells grow and mechanically compress the fistula tunnels, and they secrete locally acting cytokines that help induce healing.” Results of the procedure have been encouraging, and patients appreciate its minimal invasiveness.
Nevertheless, legacy surgeries like the J-pouch procedure that’s long been a functional “cure” for ulcerative colitis remain important in the IBD surgical toolkit.
“This is a core competency for us at Keck Medicine,” Cologne notes. “It’s a highly specialized procedure. Surgeons need additional training to do it well.” And while J-pouch surgery itself hasn’t fundamentally changed since the mid-1970s, how Cologne and his colleagues perform it has, with the use of minimally invasive approaches that yield faster recovery and better cosmesis for patients.
Ultimately, whether or not to take a surgical route in treating IBD is a personal decision.
“Some patients don’t want to be on medication for a lifetime; others don’t want surgery at all and won’t throw in the towel until they’ve tried all medical options available,” Cologne says.
Physicians serve their patients best when they lay out all those options, as well as the surgical ones, for patients to consider, and this is where working with a multidisciplinary specialist team pays dividends.
“Our physicians who specialize in IBD will often send patients who don’t need surgery to surgical consults to learn about surgical options and what they entail from someone who performs them,” Cologne notes. “These are complicated procedures, and it can take a couple of visits for the patient to truly understand what we’re considering.”
And those options are worth a look, especially if medical interventions fall short. “The goal is to get the patient feeling better so they can get back to their life,” Cologne says. “And if surgery is the best way to achieve that goal, then let’s do it. I’ve heard so many patients say afterward, ‘Why did I wait so long to do surgery? I feel so much better now!’”
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