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Types of Surgery for Ulcerative Colitis

Ulcerative colitis is a chronic Inflammatory Bowel Disease (IBD) that inflames the inner mucosal lining of the colon, causing ulcers, frequent passing of bloody watery stools, gas and bloating. When conservative treatment for ulcerative colitis fails, surgery is the next approach. Emergency surgery is also performed for complications of ulcerative colitis, such as perforation of the colon, massive bleeding in the colon and toxic megacolon (dilation, bacteria and gas buildup in the colon).

  1. Facts

    • Removing the entire colon and rectum is the only permanent cure for ulcerative colitis. The entire colon is removed even if only a portion is affected. Removing the colon changes how solid waste is eliminated. Stool will be eliminated in a liquid form since the water will not be reabsorbed into the body. Stool will pass through the anus or through an ostomy or opening in the right lower abdomen below the belt line.

    Proctocolectomy with Ileostomy

    • There are three types of surgical approaches in the treatment of ulcerative colitis. The first is proctocolectomy with ileostomy, which involves the removal of the entire colon and rectum. A stoma (a small opening in the abdomen) is then created and is attached to the end portion of the small intestines (ileum). Stool will be eliminated through the small intestines into the stoma and emptied into an ostomy bag covering the stoma.

    Ileoanal Anastomosis or Pull-Through Method

    • In this procedure the colon and rectum are removed leaving the muscles of the outer rectum intact. The ileum is attached to the rectal muscles to create a pouch where stool will be collected and eliminated. A temporary ileostomy is done to facilitate elimination until the pouch heals. Approximately 10 to 12 weeks postoperatively the ileostomy is closed and stool is passed normally.

    Continent IIeostomy

    • In this approach the entire colon is removed. The ileum is used to create a pouch in the lower abdomen in direct connection to a small leakproof opening into your side. A valve is created to avoid leakage at the skin opening. Stool is emptied by inserting a tube into the skin opening. An ostomy bag is worn over the leakproof opening for a few months after surgery. This is not a popular procedure today.

    Considerations

    • Education and discussion with your health care team about the surgical procedure, preparation for surgery, postoperative care and possible complications will make you a better patient in dealing with your surgery. Advice on adaptation to life after surgery and the availability of support groups will add to your quality of life.

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