Ulcerative colitis surgery is usually a proctocolectomy, i.e. removal of the colon and rectum. After the proctocolectomy, the surgeon creates a kind of artificial rectum from a piece of small intestine. This is intended to take over the function of the removed rectum. The patient usually remains continent in this way, so that a permanent artificial anus can be avoided.
Here you will find further information as well as selected specialists and centers for ulcerative colitis surgery.
Ulcerative colitis is limited to the large intestine (colon). Therefore, a colectomy(removal of the colon) or proctocolectomy can practically cure the disease.
Ulcerative colitis surgery can also reduce the risk of colon cancer and prevent toxic megacolon.
Another important aim of the operation is to preserve sphincter function. Therefore, after removal of the colon, the small intestine is connected to the edge of the sphincter muscle. In this way, an artificial anus can often be avoided.
There are the following indications for ulcerative colitis surgery, i.e. reasons for performing the operation:
Surgery is also necessary if the ulcerative colitis
Surgery can also be considered to prevent colon cancer or to reduce the amount of medication taken.
Ulcerative colitis is one of the chronic inflammatory bowel diseases and affects large parts of the colon © bilderzwerg | AdobeStock
Ulcerative colitis surgery, i.e. removal of the colon, is an extensive procedure. Careful preparation of the patient is required to ensure that it proceeds without complications and heals as desired.
One general measure is to improve heart and lung function. The patient should perform breathing exercises and refrain from smoking.
At the latest on the day before the ulcerative colitis operation, the patient must have a complete bowel movement. For this purpose, the patient is given a laxative drinking solution and precise instructions on intake and diet.
During ulcerative colitis surgery, at least the affected sections of the colon are removed. In most cases, however, the surgeons remove the entire colon and rectum. Only then is the patient cured of the disease.
If the sphincter muscle still functions well, the natural anus can be preserved. This is feasible in around 90 % of cases.
In many cases, ulcerative colitis surgery can be performed using a minimally invasive technique. In this case, no large tissue incision is necessary.
However, if there are too many adhesions in the abdomen or too many affected parts of the bowel, the doctors perform the operation openly. They then make a vertical incision in the middle of the abdomen.
Once the colon has been removed, the stool passage is reconstructed. To do this, the surgeon stretches the small intestine and attaches it to the anus above the sphincter muscle (ileoanal anastomosis).
He then forms a so-called J-pouch from loops of small intestine. A pouch is a reservoir that is intended to replace the function of the rectum, i.e. the storage of bowel contents before emptying. This procedure is known as a restorative proctocolectomy.
In the past, an artificial small bowel outlet (ileostomy) was necessary because the colon, including the sphincter muscle, was completely removed. With the pouch construction, there is no longer an absolute necessity for a permanent artificial bowel outlet.
However, if the sphincter cannot be retained, a permanent ileostomy must be created.
The surgeon usually creates a temporary artificial anus. This protects the fresh intestinal sutures (anastomosis) after the operation.
A temporary ileostomy is also intended to protect the diseased sections of bowel so that they can heal better.
Before the operation, patients with severe ulcerative colitis have up to 30 bowel movements per day. After ulcerative colitis surgery, the frequency of bowel movements is ideally reduced to around 5 to 10 bowel movements per day.
However, bowel movements will always remain somewhat thin to mushy after the surgical treatment.
Before ulcerative colitis surgery, the doctor will discuss the possible complications with the patient. As with all operations on the abdominal cavity, complications such as
can occur.
In rare cases, ulcerative colitis surgery can also lead to peritonitis, which can be life-threatening. The risk of this is greatly increased if the suture of the two remaining intestinal ends does not heal smoothly and intestinal contents containing bacteria leak into the abdominal cavity. To avoid this, the intestinal suture is performed with the utmost precision.
Despite a thoroughly cleaned bowel, bacteria can enter the abdominal cavity during ulcerative colitis surgery. For this reason, doctors pay particular attention to signs of wound infection after the procedure.
After ulcerative colitis surgery, patients are usually cared for in the surgical intensive care unit for a few days.
During or after the operation, the doctors place several tubes, which are removed as quickly as possible. These include
Ideally, the patient is transferred to the normal ward the day after the operation. They can now start to drink fluids (e.g. tea and possibly soup). However, the fluid balance still needs to be balanced by infusions. The patient receives pain therapy to relieve the pain.
The patient should then stay out of bed as much as possible and walk around.
If everything goes well, the patient can be discharged just six to seven days after the operation.
After around three months, the intestinal suture is checked using X-rays. If the findings are normal, the doctors can then move the artificial anus back into place.
After ulcerative colitis surgery, lifelong care by an experienced internist is recommended.
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