Ulcerative Colitis

Surgery

Ulcerative colitis affects only the large intestine, so surgery that removes the entire large intestine can cure the disease. Some people who have ulcerative colitis in the entire colon (pancolitis) eventually need surgery to remove the colon.

People may need surgery for ulcerative colitis in several situations, such as when other therapy fails to manage symptoms, when holes develop in the large intestine, or if dysplasia is found during colonoscopy or biopsy.

Should I have surgery to cure ulcerative colitis?

Surgery Choices

Removal of the colon to cure ulcerative colitis involves one of these surgeries:

• In ileoanal anastomosis, the surgeon removes some or all of the large intestine (colon) and the diseased lining of the rectum. Then the end of the small intestine (the ileum) is connected to the anal canal. The anal sphincters are saved and this allows you to have bowel movements without an ostomy.
• In proctocolectomy and ileostomy, the large intestine and rectum are removed, leaving the lower end of the small intestine (the ileum). The surgeon sews the anus closed and makes a small opening called a stoma in the skin of the lower abdomen. The ileum is connected to the stoma, creating an opening to the outside of the body. Stool empties into a small plastic pouch called an ostomy bag that is applied to the skin around the stoma.
• In continent ileostomy, the surgeon removes the large intestine (colon) and creates a pouch and a valve from the lower end of the small intestine (the ileum). The surgeon then connects the valve to an opening (stoma) in the skin of the lower abdomen. After this surgery, you can insert a tube into the valve to release stool from the intestines.

What To Think About

Ileoanal anastomosis is performed most often. Proctocolectomy with ileostomy is preferred for people who cannot tolerate anesthesia for a long period of time because of illness or age.

Both children and adults may have ileoanal anastomosis, which may be done in stages to reduce the risk of complications. A temporary ileostomy is created first, with the ileum pouch completed 3 to 6 months later. Surgery can improve a child's well-being and quality of life and restore normal growth and sexual development.

In the past, many people who had surgery for IBD had an ileostomy and wore an ostomy bag outside the abdomen. Newer surgeries like ileoanal anastomosis or continent ileostomy can eliminate the need for an ostomy bag with fairly good results when they are done by a trained surgeon. Traditional ostomy surgery is easier and may have fewer risks and complications than the newer procedures, but some people may be less satisfied with the results.

People with ulcerative colitis may choose to have their colon removed because their symptoms cause a poor quality of life. They also may want the surgery to prevent the possibility of colon cancer.

In most cases, surgery can be scheduled at your convenience. Emergency surgery usually is not needed unless an acute attack causes toxic megacolon, severe uncontrolled bleeding, or a spontaneous rupture in the intestine. The risk of complications after surgery can be high if surgery is done during a severe or rapidly worsening attack or if emergency surgery is needed. If toxic megacolon has developed, surgery may be the only option to save a person's life.

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Author:	Monica Rhodes	Last Updated: November 14, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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