initial meeting with a surgeon (small bowel resection)

After much reluctance, on my behalf, I finally agreed to meet with a surgeon to discuss a possible small resection and I was wondering if anyone has any recommended questions to ask the surgeon?

A bit of background - I have CD with a small stricture in the ileum. I have infrequent minor flares (D or general discomfort queasiness) which honestly don't really bother me but my big flares involve inflammation to the level of obstruction (vomiting, bloating, pain, extreme fatigue, etc... for 1+ days followed by a days of D). I've tried a number of meds: Asacol and 1-2 of it's relatives (seemingly useless), 6MP (some success and am currently on it again for a third try), Humira (an absolute nightmare... worst 3 months, health-wise of my life), and steroids (successful but only used for short term purposes) and my gastro thinks surgery is the next option. I've always been reluctant to go that route for a number of reasons (I've had a number if infections, I fear once I start down this path - it will just be surgery after surgery, etc...) but as my major flares increase, I'm at least open to the idea.

So, if anyone who has been through this before could share some questions, concerns, whatever for my meeting with the surgeon and/or share some stories, I would greatly appreciate it. The appointment is this Monday and I tried to join the board last weekend but had some trouble with my account getting activated, so I apologize for the late notice but I thank those, in advance, who can share some thoughts.

The stricture is fairly small (I think?) - less than 10 cm - and I've had it for over 10 years. I've had a 2 MRIs and it hasn't become worse in the years between the 2.

I would guess your location questions were for the doctor but if not: Beth Israel in Boston.

Your reply is very helpful... thank you.

If you've had your stricture for over 10 years and it hasn't become any worse, then I question the need for a surgery which could make things worse. Resections give some people relief for many years, but other people flare up again almost straight away. Or they have problems with bile diarrhoea, IBS, etc.

It really depends on how bad your symptoms are. Some people don't have much of a choice because they are obstructing all the time. You mentioned infrequent 'minor' flares and 'big' flares - how often does each type of flare occur?

I guess another question is if the surgeon or GI thinks that the stricture is primarily from scar tissue or inflammation. If what you mean by "big flares" are obstructive episodes and the stricture is primarily scar tissue, then surgery may help prevent the obstructions but you will still need medication for the rest of the inflammation in your intestines. Have you had a CT or MRI to see what's going on with the stricture? Sometimes they can't tell for sure if it is scar tissue or inflammation. For me during my last obstruction, IV prednisone didn't help at all, which is how they decided the stricture was primarily scar tissue. After surgery, the surgeon said there was some inflammation as well, but that medication never would have helped much at that point.
If the stricture comes and goes and is inflammatory in nature, then you probably would be better off trying different medication. My disease was solely located in my ileum, so that was another reason that surgery made sense, in addition to the fact that it got so bad that I was only on fluids. I know it's a tough decision, but if you are having increasing obstructions, then surgery would definitely help with that.

I agree that you should try to find out what the stricture is being caused by. Also, you may want to ask what you might reasonably expect your bowel movements to be like after surgery, and by that I mean after you have completely healed. I had a resection of about 20 cm of ileum and a small amount of colon a year and a half ago. I have to admit that I don't remember what normal bowel movements are like anymore, 13 years of Crohn's to blame for that, but my new normal is a cross between not going for a few days and then having diarrhea. I feel pretty good even dealing with runs to the bathroom so I'm okay with my decision to have surgery but you should understand what might end up being your new normal.

Quick follow up: thanks again to all those who replied to this thread and helped me prepare for this appointment. The doctor was VERY thorough and answered almost all of my questions without me even needing to ask them. His professional opinion is that I don't need to rush into surgery, unless I've personally reached exhaustion. Further, he suggested that I discuss trying a different biologic with my gastro.