Treatment for Ulcerative Colitis: Surgery
Between 25 to 40% of those suffering from ulcerative colitis will
eventually require surgery. The reasons for resorting to
surgery can be because medical treatments are not effective, cancer,
bleeding, or rupturing of the colon.
Conventional open surgery or laparoscopic surgery, a minimally invasive
technique, can be used. Patients who are candidates for
laparoscopic surgery experience shorter hospital stays and easier
recovery.
Proctocolectomy
A proctocolectomy is a surgical procedure that involves removing the
colon and the rectum. Unlike Crohn's disease, once the colon
has been removed ulcerative colitis is cured.
Unfortunately diseases associated with ulcerative colitis may develop
or progress following surgery. Most commonly being sclerosing
cholangitis (a liver condition) and Ankylosing spondylitis
(inflammation of the lower back).
In addition to the removal of the colon and rectum, a small opening,
called a stoma or an
ostomy,
is made in the abdominal wall.
The end of the small intestine is attached to the skin of the abdomen
forming an ileostomy.
Waste continues to travel through the small intestine and exits the
body via the stoma. The size of the stoma is about the size
of a quarter and is located in the lower right part of the
abdomen. A pouch is worn over the stoma to collect
the waste material. The pouch is then emptied when needed.
Colostomy
A colostomy involves surgically removing a portion of the colon or the
rectum. The remaining colon is connected to an opening
(stoma) in the abdominal wall. Waste is collected in an
external pouch as with an ileostomy.
Continent Ostomy
An alternative to the ileostomy is a continent ostomy. An
internal pouch is created under the abdominal wall which is used to
collect waste. A valve is created at the opening.
The internal pouch is drained by a rigid tube place through the
valve. The pouch is drained several times a day and frees the
patient from having to wear any external pouch.
Ileal Pouch Anal Anastomosis
Sometimes called a restorative proctocolectomy or ileoanal
pull-through, an ileal pouch anal anastomosis (IPAA) preserves part of
the anus. This allows the patient to continue to
have normal bowel movements. The surgeon removes only the
inside of the rectum leaving the outer muscles of the anus.
A pouch is created from the end of the ileum which is then attached to
the inside of the anus. Waste accumulates in the pouch and
is passed through the anus in the normal manner.
Bowel movements are more watery and more frequent (six on average per
day) but the patient will not have to wear a permanent external pouch.
A possible complication is inflammation of the internal pouch called
pouchitis. Pouchitis can be treated with 5-ASA
medications. About 8 to 10% will experience a pouch failure
which requires that the pouch be removed and a permanent ileostomy is
performed.