Surgery for Ulcerative Colitis

Ulcerative colitis is chronic inflammatory disease of the colon and rectum.

The most common symptoms of ulcerative colitis include increased frequency of loose stools often with bleeding. The disease typically follows a waxing – waning course with acute flare ups with intervening periods of remission (cooling down).

The diagnosis of ulcerative colitis is typically made at colonoscopy (i.e., endoscopic examination of colon) and biopsy.

The first line of treatment for uncomplicated ulcerative colitis is medical with aminosalicylates. The more severe form of disease would require corticosteroids, immunosuppresants, Biologics or JAK inhibitors. The definitive treatment plan is provided by the medical team following detailed clinical evaluation.

Complications of ulcerative colitis include massive bleeding, perforation and toxic megacolon.

Development of colorectal cancer is one of the most serious complication of ulcerative colitis. Cumulative risk of development of cancer reaches 25% at 25 years, rising up to 65% at 40 years of disease duration. Patients with involvement of entire colon have increased risk as compared to those with disease confined to the left side of the colon. A surveillance colonoscopy is recommended every 1-2 years beginning 8 years after pancolitis and 12-15 years after the onset of left sided colitis.

Surgery is advised in patients with ulcerative colitis when

  • Medical treatment fails to adequately control the disease
  • Complications of medical management
  • Complications of ulcerative colitis such as perforation, bleeding, cancer
  • Some patients with fulminant colitis and toxic megacolon where medical management fails may need surgery.
  • Performed in usually in 2 stages (elective) or 3 stages (emergency)
  • Can be performed robotic/laparoscopic/open

IPAA is the modern surgical procedure for ulcerative colitis and stands for Ileal Pouch Anal Anastomosis. The procedure has following important steps:

  • Removal of entire colon and rectum
  • Creation of pouch of small intestine and joining it to anal canal
  • Creation of temporary diverting loop ileostomy

Vast majority of patients are satisfied and report a good quality of life after IPAA.

Your surgical team will discuss in detail with you the procedure, stages, best approach and expected outcomes once the decision for surgery is made.

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