Colectomy
One of the most common surgical options for ulcerative colitis is a colectomy. During a colectomy, the surgeon removes the entire colon and rectum. This procedure is often recommended for patients with severe symptoms or complications, such as uncontrolled bleeding or the development of cancerous cells. After a colectomy, the surgeon may create an ileostomy or an ileoanal pouch to redirect the flow of waste. An ileostomy involves creating a small opening in the abdominal wall and attaching the end of the small intestine to it. Waste is then collected in a bag worn outside the body. An ileoanal pouch, also known as a J-pouch, is created using the small intestine. This pouch is then connected to the anus, allowing for a more natural way to pass stools.
Proctocolectomy
Another surgical option for ulcerative colitis is a proctocolectomy. During a proctocolectomy, both the colon and rectum are removed. This procedure is typically recommended for patients with extensive disease that involves the rectum. After a proctocolectomy, a temporary ileostomy may be created to allow for healing. In some cases, a permanent ileostomy may be necessary if the patient is unable to undergo further surgeries to create an internal pouch. A proctocolectomy with ileal pouch-anal anastomosis (IPAA) is another option. With IPAA, a pouch is created from the small intestine and connected to the anus, eliminating the need for an ileostomy. This allows for more normal bowel function. However, it may require multiple surgeries and a temporary ileostomy during the healing process.
Other Surgical Procedures
In addition to colectomy and proctocolectomy, there are other surgical options available for ulcerative colitis. These include strictureplasty, which involves widening a narrowed section of the intestine to improve the flow of stool. Strictureplasty is often used for patients with strictures caused by scarring from inflammation. Another option is a total proctocolectomy with permanent ileostomy. This involves removing both the colon and rectum and creating a permanent ileostomy. Some patients may also undergo a subtotal colectomy, where a portion of the colon is removed but the rectum is preserved. This procedure is typically done for patients with less severe disease or those who wish to preserve their rectum for a possible future surgery.