Our Summary

This study examined the use of segmental colectomy (SC), a procedure where a part of the colon is removed, in patients with ulcerative colitis (UC), a long-term condition that results in inflammation and ulcers of the colon and rectum. The goal was to see if SC could be an alternative to another procedure known as ileal pouch-anal anastomosis (IPAA).

The study included 72 patients with UC who underwent SC for various reasons like colon cancer, diverticulitis (inflammation or infection of small pouches in the colon), colon stenosis (narrowing of the colon), and other conditions. After the surgery, three patients died and five experienced an early flare-up of UC.

Following an average follow-up period of about 3 years, around 35% of the patients had to undergo another surgery, most commonly another colectomy or a total coloproctectomy (removal of the entire colon and rectum). The reasons for these additional surgeries included worsening of colitis, cancer, or unknown reasons.

The study found that the severity of colitis before the surgery was associated with an increased risk of early flare-up and the need for additional surgery.

The researchers concluded that SC could potentially be an alternative to IPAA in selected UC patients who do not have active colitis. However, the risk of postoperative complications and the need for further surgery should be considered.

FAQs

  1. What is segmental colectomy and why is it used in patients with ulcerative colitis?
  2. How does the severity of colitis before surgery affect the outcomes of segmental colectomy?
  3. Can segmental colectomy be a potential alternative to ileal pouch-anal anastomosis for patients with ulcerative colitis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about colectomy is to carefully follow post-operative instructions, including proper wound care, pain management, and dietary recommendations. It is also important to attend all follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider promptly. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support recovery and long-term digestive health after colectomy.

Suitable For

Patients with ulcerative colitis who do not have active colitis are typically recommended for colectomy. Other patients who may be recommended for colectomy include those with colon cancer, diverticulitis, colon stenosis, and other conditions that cannot be managed with medication or other treatments. Additionally, patients who have a high risk of developing colon cancer due to conditions like familial adenomatous polyposis (FAP) may also be recommended for colectomy.

Timeline

Before colectomy:

  • Patient is diagnosed with ulcerative colitis (UC)
  • Patient may undergo various treatments such as medication, dietary changes, and lifestyle modifications
  • If conservative treatments fail, surgery may be recommended
  • Patient undergoes preoperative evaluations and assessments to determine the necessity of surgery

After colectomy:

  • Patient undergoes the colectomy procedure, where a part or the entire colon is removed
  • Patient may experience postoperative complications such as infection, bleeding, or bowel obstruction
  • Patient may need to stay in the hospital for a few days to recover
  • Patient may need to make dietary and lifestyle changes to adapt to life without a colon
  • Patient may need to undergo additional surgeries in the future, depending on the underlying condition and complications
  • Patient undergoes follow-up evaluations to monitor their health and adjust treatment as needed

What to Ask Your Doctor

  1. What are the potential risks and complications associated with colectomy?
  2. How will my quality of life be affected after colectomy?
  3. Will I need to make any dietary or lifestyle changes after the surgery?
  4. What is the likelihood of needing additional surgeries after colectomy?
  5. How long is the recovery period after colectomy?
  6. Will I need to take any medications after the surgery?
  7. How will colectomy affect my risk of developing other conditions, such as colon cancer?
  8. What are the alternative treatment options to colectomy for my condition?
  9. How experienced are you in performing colectomy procedures?
  10. Can you provide me with information on support groups or resources for patients who have undergone colectomy?

Reference

Authors: Frontali A, Cohen L, Bridoux V, Myrelid P, Sica G, Poggioli G, Espin E, Beyer-Berjot L, Laharie D, Spinelli A, Zerbib P, Sampietro G, Frasson M, Louis E, Danese S, Fumery M, Denost Q, Altwegg R, Nancey S, Michelassi F, Treton X, Panis Y. Journal: J Crohns Colitis. 2020 Dec 2;14(12):1687-1692. doi: 10.1093/ecco-jcc/jjaa107. PMID: 32498084