Our Summary

This research paper looks at a condition called inflammatory bowel disease (IBD) proctocolitis, which affects the digestive system. In many cases, doctors can help control the symptoms and disease by removing part of the patient’s rectum - a procedure called a proctectomy. However, this operation can potentially cause other health problems.

The paper suggests that in certain situations, it might be better to leave the rectum in place, either connected or disconnected from the rest of the intestines. The authors examine the few situations where this might be a good approach and discuss the potential consequences of such a decision.

FAQs

  1. What is a proctectomy and how can it help patients with IBD proctocolitis?
  2. In what situations might it be advisable to leave the rectum in place rather than performing a proctectomy?
  3. What are the potential implications of leaving the rectum in situ for patients with inflammatory bowel disease?

Doctor’s Tip

A helpful tip a doctor might tell a patient about proctectomy is to make sure to follow post-operative care instructions closely, including proper wound care, pain management, and dietary restrictions. It is important to attend follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support the healing process and overall recovery after a proctectomy.

Suitable For

Patients with severe proctocolitis from inflammatory bowel disease (IBD) who have failed medical therapy or have complications such as dysplasia or cancer are typically recommended proctectomy. Additionally, patients with familial adenomatous polyposis (FAP) or other hereditary colorectal cancer syndromes may also undergo proctectomy as a preventive measure. Patients with refractory ulcerative colitis or Crohn’s disease involving the rectum may also be candidates for proctectomy.

Timeline

Before proctectomy:

  1. Symptoms: Patients with proctocolitis may experience symptoms such as rectal bleeding, diarrhea, urgency, and abdominal pain.
  2. Diagnosis: Patients undergo diagnostic tests such as colonoscopy and imaging studies to confirm the presence of proctocolitis.
  3. Medical management: Patients may initially be treated with medications such as anti-inflammatory drugs, immunosuppressants, and biologics to control symptoms and inflammation.
  4. Failure of medical management: If medical management fails to provide adequate symptom relief or disease control, surgery may be recommended.

After proctectomy:

  1. Surgery: Proctectomy is performed to remove the diseased rectum. The surgeon may create an ileostomy or perform an ileoanal pouch procedure to restore bowel continuity.
  2. Recovery: Patients undergo a period of recovery in the hospital before being discharged home. They may experience pain, discomfort, and changes in bowel function.
  3. Follow-up care: Patients are monitored closely postoperatively to ensure proper healing and to manage any complications that may arise.
  4. Long-term management: Patients may require ongoing medical management, such as medication adjustments or dietary modifications, to maintain remission and prevent complications.
  5. Quality of life: Proctectomy can significantly improve quality of life for many patients by alleviating symptoms and reducing the risk of disease progression.

What to Ask Your Doctor

  1. What are the reasons for recommending a proctectomy in my case?
  2. What are the potential risks and complications associated with a proctectomy?
  3. Are there any alternative treatments or procedures that could be considered instead of a proctectomy?
  4. How will a proctectomy impact my quality of life and daily activities?
  5. What is the recovery process like after a proctectomy?
  6. Will I need a permanent ostomy after a proctectomy?
  7. How will a proctectomy affect my ability to have bowel movements in the future?
  8. What are the long-term outcomes and success rates of a proctectomy for patients with my condition?
  9. Are there any lifestyle changes or dietary modifications that I will need to make after a proctectomy?
  10. How often will I need follow-up appointments after a proctectomy?

Reference

Authors: Savitch SL, McGee M. Journal: Surg Clin North Am. 2025 Apr;105(2):423-433. doi: 10.1016/j.suc.2024.10.005. Epub 2024 Nov 26. PMID: 40015825