Ulcerative Colitis Surgery

Ulcerative colitis is a long term, chronic inflammatory disease affecting the lining of large intestine. It is characterized by the presence of very small ulcers and abscesses in the lining of rectum and colon. These can flare up periodically, leading to diarrhea and bloody stools. Abdominal pain and anemia are also present. This disease has a relapsing nature, and the remission time can last from weeks to months. Medical management is usually chosen to treat this disease, and ulcerative colitis surgery is usually reserved for very severe cases and performed as a last resort.

When Surgery Is Necessary for Ulcerative Colitis?

Not everyone suffering from this disease requires surgical treatment. 23-45 % of patients require surgical removal of colons. Surgeries are recommended in the following conditions:

  • When medical management is not sufficient to control symptoms
  • Severe relapse not responding to treatment
  • Excessive bleeding or ruptured colon
  • The risk of developing cancer
  • Severe side effects of medication making it impossible to continue with them
  • Toxic mega colon. In this condition the large intestine gets dilated and there is increased risk of perforation

Types of Ulcerative Colitis Surgery

Four types of surgeries are performed for treating ulcerative colitis:

1. Ileal Pouch-Anal Anastomosis (IPAA)

This is the most commonly performed surgery for ulcerative colitis. Since during this procedure an ileal pouch is created and the small intestine is joined with the anus, which allows the patients to empty the bowels in a natural way, it is preferred by many patients.

This procedure has two steps. During the first step, the large intestine is removed while the anus and anal sphincter is retained. A pouch is formed using part of small intestine (ileum) which is joined with the anus. A temporary ileostomy is created which serves to remove the waste products while the pouch heals. After ten to twelve weeks, the next step is performed to close the temporary ileostomy.

2. Total Proctocolectomy with Ileostomy

During this procedure, the large intestine is completely removed, including colon, rectum and anus. An opening is created on the abdomen where the end of the small intestine is joined. A bag or pouch is attached to that opening to collect the waste products. The bag can be emptied and changed when required, and is odor free.

Note: This surgery gives good results for the older age group and for those patients who can't receive longer anesthesia.

3. Colectomy

The diseased part of colon is removed during this surgery and the healthy part is left intact. Depending upon the condition of the remaining large intestine, the healthy part will be either connected to restore the continuity of the gut, or be routed to an abdominal opening with a colostomy bag. It is usually possible to re-attach the remaining intestine thanks to the modern technique.

4. Continent Ileostomy

This procedure is not frequently performed for ulcerative colitis. It is a technically difficult surgery reserved for those who cannot have IPAA or want to stop using the external bag. During this procedure, the large intestine is removed, and a pouch is created using the small intestine which holds the waste products. This reservoir is drained by the valve through abdominal wall.

This is not an ideal choice as the results are not very reliable and follow up surgeries may be required. It is reserved for those patients who cannot have any other surgery like IPAA.

Possible Complications of the Surgery

There are many possible complications of ulcerative colitis surgery, some of them are:

  • Stricture formation (most commonly anal canal stricture)
  • Infection and/or pelvic sepsis
  • Fecal incontinence
  • Pouch failure
  • Sexual dysfunction
  • Development of dysplasia/cancer in the pouch

What Benefits Can Ulcerative Colitis Surgery Bring to You?

Ulcerative colitis is the disease of large intestine or the colon, if the colon is removed, the disease is cured. Ulcerative colitis is associated with a lot of symptoms like abdominal pain, diarrhea and anemia, which disappear when the large intestine is removed.

Another significant benefit of the surgery is cancer prevention. People with ulcerative colitis are more likely to develop colon cancer. The risk is greater in those who have the disease involving the whole of the colon, as compared to those who only have disease of the lower parts of the large intestine. 

Surgery Influence on Daily Life

1. Diet

After the surgery, a balanced and nutritious diet is required. You should also consume more liquids and salt because you will lose more of them with a stoma. Initially you may need to have low residue diet and the dietitian can guide you accordingly. However, there are no particular foods to avoid.

2. Sex and Pregnancy

Although sexual function usually returns back to normal after full recovery, sometimes men can experience impotence. These surgeries can also affect fertility. It is always better to discuss these issues with your consultant before planning to have a baby. Women who received ulcerative colitis surgery are advised to undergo a caesarean section if they get pregnant. 

3. Emotional Reactions

Everyone reacts to the procedure in a different way. Some people are angry, some feel sad or anxious, and many do feel better after the surgery. Depression is very common in patients who get a stoma, and they need special attention, care and support. There are a lot of support groups that can help patients deal with it. Your doctor and stoma care nurse can also give guidance.

 
 
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