The Use of Surgery for Ulcerative Colitis

Ulcerative colitis (UC) is a chronic, inflammatory bowel disease that causes inflammation in the digestive tract. It is usually only in the innermost lining of the large intestine (colon) and rectum. It ranges from mild to severe. Ulcerative colitis is usually not a very serious condition and as such can be treated and managed with the help of medications, changes in lifestyle and diet changes. Having said that, ulcerative colitis can never really be cured for good, which means that there are always chances that flare-ups might occur in patients from time to time.

Flare-ups due to UC tend to grow more severe with time, and what was once an occasional disturbance now becomes a debilitating condition. At its worst stage, UC can manifest itself in the following ways:

• Can cause loss of appetite which eventually causes a dramatic loss of weight
• Increased rectal bleeding which can further lead to anemia
• Severe abdominal pain and cramps
• Bloody diarrhea
• Fatigue or fever
• Scarring within the bile ducts
• Pain in joints or the rectum
• Bloating or the presence of blood in stool
• Constipation and the inability to empty bowels
• Leaking of stool or the urgent need to defecate

The presence of these symptoms can make a patient become debilitated, which is when a patient becomes weak and infirm. Since you cannot completely cure ulcerative colitis, it becomes necessary in the case of some patients to perform surgery in order to cut away the problematic area of the colon, hence reducing these debilitating and harmful symptoms.

It has been found that UC typically develops in early adulthood, and from the onset of that the symptoms keep getting more severe as the patient ages. In fact, about 25 to 45 percent of those diagnosed with ulcerative colitis during their youth will have to undergo some form of surgery to treat this condition.

When is surgery used to treat UC?

Surgery to treat UC is usually needed and is considered as the final option of treatment if the patient exhibits the following:

• Sudden, severe symptoms of toxic or fulminant colitis which do not improve with drug therapy and supportive therapy in the hospital
• Toxic megacolon which is characterized by grossly dilated colon and the presence of toxicity
• The symptoms do not respond effectively to medications and drugs
• Presence of abnormal cells in the colon which could lead to higher risk of developing colon cancer
• Symptoms of colitis that occur beyond the intestines

Types of surgery for UC

When surgery is needed, surgeons may apply various techniques to treat UC:

• Colectomy: This is a surgical procedure to remove all or part of your colon. Colectomy surgery usually also requires other procedures in order to reattach the remaining portions of your digestive system and permit waste to exit your body. There are various types of colectomy operations, and these include:
  • A total colectomy that involves the removal of the entire colon
  • A partial or subtotal colectomy that involves removing only a part of the colon 
  • A hemicolectomy which involves removing the right or the left portion of the colon
• Proctocolectomy: A proctocolectomy is a surgical procedure where both the rectum and the colon are removed. It is the more common and widely used surgical method to treat ulcerative colitis. A proctocolectomy can be done in various ways.

Permanent ileostomy

After the entire colon is removed the stool still needs to be eliminated, so the surgeon creates an opening in the abdominal wall known as a stoma. A bag is then attached externally into which the stool is collected after passing through the small intestines and stoma. If your ileostomy is temporary, then part or your entire colon is removed but you keep at least a part of your rectum.

In the case of a permanent ileostomy, the surgeon will remove or bypass your rectum, colon, and anus. Patients who have undergone permanent ileostomy need to wear an external bag at all times in order to catch their waste products. This surgery is done if your rectum or colon is not able to function properly.

An ileostomy is usually needed when the large intestine problems cannot be treated through medications and drug therapy.

Ileal pouch anal anastomosis (IPAA)

The ileal pouch anal anastomosis is a surgical procedure that can restore gastrointestinal continuity after the surgical removal of the colon and the rectum. Various conditions, which include inflammation, cancer, or infection, may necessitate the complete removal of the colon and rectum in some patients.

Also known as the pelvic pouch or restorative proctocolectomy, this procedure does not involve an external pouch. Instead, the small intestine is used to form an internal pouch, a J-pouch, and the stool can be collected there. Two or more loops of the intestine are stapled or sutured together to form a reservoir for the stool. There is no need for an external pouch since the small intestine acts as the removed rectum, and the individual can pass stool through the anus as usual. The stool reservoir created by the loops of the intestine is attached to the anus for reestablish the anal fecal flow.

Continent ileostomy

This procedure, also known as kock pouch, is done when someone with a permanent ileostomy wishes to convert it into an internal pouch. It is an alternative to end ileostomy for patients who have undergone the total proctocolectomy. In this procedure, the external pouch is joined to the skin with a nipple valve and the small intestines act as the rectum. When the patient needs to drain the pouch, they have to insert a catheter into the pouch and drain the stool. 

Continent ileostomy is usually prescribed to selected patients with ulcerative colitis who cannot have a restorative proctocolectomy. It is also the surgery prescribed to some patients for whom the restorative proctocolectomy or end ileostomy has failed to produce any results.

Ulcerative colitis might require surgery. For this, one needs to check with a medical expert and only then proceed. If you feel like surgery is not the best way to move forward, consult with a specialist in order to find out the best alternative for you.