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Ulcerative Colitis

Ulcerative colitis is a form of inflammatory bowel disease that affects the colon and rectum. It is a chronic illness requiring several approaches to treatment, which may include medication, dietary modifications, nutritional supplementation and possibly surgery. Surgery may be recommended for patients who have stopped responding to their medication. Other patients choose to undergo surgery to improve their quality of life and avoid life-long medication use. Some patients require life-saving emergency surgery. Up to one-third of people with ulcerative colitis will eventually require surgery.

Common Procedures for Ulcerative Colitis

Depending on the extent of your disease, age and overall health, there are two surgical approaches that may be recommended to you. The first involves the removal of the entire colon (the main part of the large intestine) and the rectum (the lowest part of large intestine where formed stool is held until it’s passed out of the body through the anus). After the colon and rectum are removed or bypassed, waste no longer comes out of the body through the rectum and anus. Digestive contents now leave the body through a stoma (an opening on the abdomen). The drainage is collected in a pouch that sticks to the skin around the stoma. The pouch is fitted to you personally. It’s worn at all times and can be emptied as needed. This procedure removes the colon and rectum and is called a total proctocolectomy with end ileostomy.

Another procedure, called J-Pouch or IPAA (ileal pouch anal anastomosis) surgery, removes the entire colon and rectum at different stages to ensure safe surgery and excellent outcomes. This procedure is called a ‘restorative proctocolectomy’ where the colon and rectum are removed, and the small intestine is reconfigured into a J-shaped reservoir and attached to the anal canal. Patients have a temporary stoma, but once reversed, they defecate in the traditional manner through their anus around six times per day. Your surgeon will construct a temporary opening in the abdominal wall (ileostomy) for eliminating waste. After about three months of healing, the surgeon does a second procedure to close the ileostomy, allowing you to pass stool normally.

Both procedures can be performed laparoscopically/robotically or with a traditional incision. Laparoscopic/robotic surgery uses specialized instruments inserted into the body, including tiny cameras that display images on a monitor so your surgical team can see inside your body. This technique often means a shorter recovery time in the hospital.

Once the operations are completed, patients will no longer need to be on medications to treat ulcerative colitis in their colon or rectum.

What should I look for in a surgeon?

When looking for a surgeon for inflammatory bowel disease, it’s important to find a colorectal surgeon who is board certified in colorectal surgery. There are techniques used in colorectal surgery that require the expertise and specialization of a colorectal surgeon. The surgeon should have a great deal of experience performing the surgery you are planning to undergo. More importantly, your colorectal surgeon should have sub-specialization in inflammatory bowel disease surgery, as this adds an even greater level of knowledge and skill with someone extensively trained in surgeries specific to ulcerative colitis, which means better outcomes for patients.