Our Summary

Ulcerative colitis (UC) is a chronic inflammatory condition that affects the colon and whose cause is not well understood. While medication is usually the first course of action for treatment, about 10% of UC patients end up needing a colectomy, which is a surgical procedure to remove all or part of the colon. There are numerous surgical options available today, and the choice largely depends on the patient’s specific symptoms, personal preference, and the practices of the surgeon or medical institution. This paper is a review of the current surgical procedures used in treating UC and addresses some ongoing debates and differences in practices.

FAQs

  1. What is a colectomy and why is it required for some patients with ulcerative colitis?
  2. What are the different surgical options available for ulcerative colitis patients?
  3. How is the choice of surgical operation for ulcerative colitis determined?

Doctor’s Tip

One helpful tip a doctor might tell a patient about colectomy is to carefully follow the post-operative instructions provided by the surgical team. This may include taking prescribed medications, following a specific diet, attending follow-up appointments, and gradually increasing physical activity. By following these instructions, patients can help ensure a successful recovery and minimize the risk of complications.

Suitable For

Patients with ulcerative colitis who have severe, uncontrolled symptoms that do not respond to medical treatment are typically recommended for colectomy. Other indications for colectomy in ulcerative colitis may include complications such as toxic megacolon, perforation, severe bleeding, or the development of dysplasia or colon cancer. Additionally, patients who have failed to respond to multiple medical therapies, or who have a significantly decreased quality of life due to their symptoms, may also be candidates for colectomy. The specific type of colectomy recommended will depend on the individual patient’s clinical presentation and preferences, as well as the recommendations of their healthcare team.

Timeline

Before colectomy:

  • Patient is diagnosed with ulcerative colitis
  • Patient undergoes medical treatment to manage symptoms
  • Symptoms may worsen despite medical treatment
  • Patient and healthcare team discuss surgical options
  • Decision is made to proceed with colectomy

After colectomy:

  • Patient undergoes pre-operative preparation
  • Colectomy is performed, either as an emergency procedure or elective surgery
  • Patient recovers in the hospital post-operatively
  • Patient may require a temporary ileostomy or colostomy
  • Patient undergoes follow-up appointments with healthcare team
  • Patient may experience changes in bowel function and need to adjust to life without a colon
  • Patient may undergo additional surgeries or procedures, such as ileal pouch-anal anastomosis (IPAA)
  • Patient continues to be monitored for any complications or recurrence of ulcerative colitis symptoms.

What to Ask Your Doctor

  1. What are the reasons for recommending a colectomy in my case?
  2. What are the different types of colectomy procedures available for treating ulcerative colitis?
  3. What are the potential risks and complications associated with colectomy surgery?
  4. What is the expected recovery time and post-operative care for a colectomy procedure?
  5. How will my bowel function be affected after the surgery?
  6. Will I need a temporary or permanent stoma after the surgery?
  7. What are the long-term outcomes and success rates of colectomy surgery for ulcerative colitis?
  8. Are there any alternative treatment options to consider before opting for a colectomy?
  9. How experienced is the surgical team in performing colectomy procedures for ulcerative colitis?
  10. Are there any lifestyle changes or dietary recommendations I should follow after the surgery?

Reference

Authors: Murphy B, Kavanagh DO, Winter DC. Journal: Updates Surg. 2020 Jun;72(2):325-333. doi: 10.1007/s13304-020-00719-4. Epub 2020 Feb 11. PMID: 32048178