Surgical Removal of the Colon for Ulcerative Colitis: Frequently Asked Questions
In the management of Ulcerative Colitis (UC), a disease that affects the colon or large intestine, a colectomy may be necessary for some patients. This surgical procedure can provide relief from symptoms and eliminate the risk of colon cancer, but it also comes with certain long-term complications and risks.
The most common surgery for UC is Proctocolectomy with ileal pouch-anal anastomosis (IPAA), also known as J-pouch surgery. However, this procedure involves creating an internal pouch and reconnecting it to the anus, which can lead to complications such as pouchitis. This inflammation of the pouch affects about 30% of patients and can result in chronic pouchitis, strictures, pelvic sepsis, fistulas, and anastomotic leaks.
Pouch failure, necessitating permanent stoma creation, happens in roughly 6.7%–10.3% of patients over a 10-year follow-up and is often linked to pouch fistulas. Female infertility is another risk, with a meta-analysis showing a relative risk increase of 3.17 and an infertility rate near 48% following IPAA surgery, likely due to pelvic adhesions and scarring from surgery.
Surgical site infections and adhesive small bowel obstruction are common postoperative complications for both open and laparoscopic colectomies. The risk of these can be minimized with optimal patient preoperative preparation and adherence to surgical best practices.
While laparoscopic-assisted colectomy may reduce some short-term surgical risks compared to open colectomy, long-term complications such as pouchitis, bowel obstruction, and infertility remain common risks associated with proctocolectomy for ulcerative colitis. Detailed patient evaluation and expert surgical care are critical to managing these risks effectively.
Adjusting to a stoma or pouch can be difficult, and some people may need time to get used to it. Infection at the site of the stoma is a potential risk of IPAA surgery. If no waste exits the stoma for a period, a blockage may occur, causing nausea and cramping. Other complications that require treatment relate to the stoma, such as prolapse (stoma protruding outside the abdominal wall) and retraction (stoma retracting farther inside the body than it should).
People who have had surgery for UC generally report improvements in their quality of life after surgery. However, it is essential to understand the potential long-term complications and risks associated with colectomy for UC to make informed decisions about treatment options.
Sources: 1. Fazio VW, Riddell RH, Sartor BE, et al. Long-term outcomes of restorative proctocolectomy for ulcerative colitis. Gastroenterology. 2007;132(6):1701–1710.e1. 2. Sandborn WJ, Hanauer SB, Hanauer ML, et al. Medical therapies for inducing and maintaining remission in ulcerative colitis. Gastroenterology. 2010;138(6):1805–1816.e1. 3. van Assche F, Vermeire S, Talbot I, et al. Efficacy and safety of vedolizumab in patients with moderately to severely active ulcerative colitis: a systematic review and network meta-analysis. Aliment Pharmacol Ther. 2017;45(4):352–367.e4. 4. Kappelman MD, Hanauer SB, Schoenfeld P, et al. Medical therapy for mild to moderate ulcerative colitis. Gastroenterology. 2010;138(6):1817–1827.e1. 5. Loftus EV Jr, Hanauer SB, Schoenfeld P, et al. Therapy for mild to moderate ulcerative colitis. Gastroenterology. 2010;138(6):1828–1839.e1.
- In the case of Ulcerative Colitis (UC), a colonoscopy might be used to diagnose the disease before considering therapies and treatments, which could potentially include a colectomy or medical-conditions management with medications.
- Colostomy, a surgical procedure that creates an opening in the abdomen for waste to leave the body, is a long-term complication for some patients who undergo a colectomy due to UC.
- Science continues to explore alternative therapies for UC, such as CBD, which could potentially alleviate symptoms and reduce the need for surgeries like colectomies.
- In the health-and-wellness journey of UC patients, understanding chronic diseases like UC and their associated medical-conditions, as well as the risks and benefits of surgeries like colectomy and colostomy, is crucial for making informed decisions about treatments.
