Colitis and Surgery Part 2 - Which are the Most Common Operations?

This information is about the types of surgery that may be needed in the treatment of Ulcerative Colitis (UC). You may also find other Crohn’s and Colitis UK information useful, especially our booklets Ulcerative Colitis and Living with IBD. Most of our publications are available from our website: www.crohnsandcolitis.org.uk.

Which are the most common operations?

Proctocolectomy with ileostomy

The operations most likely to be carried out for Ulcerative Colitis are described below:

Proctocolectomy with ileostomy
In this operation the whole colon is removed, together with the rectum and the anal canal. The surgeon then brings out the end of the small intestine through an opening in the wall of the abdomen. This is an ileostomy or stoma. An external bag is then fitted onto the stoma to collect digestive waste. The bag is emptied or changed when necessary. (See below for more detail on stomas.)

Restorative Protocolectomy with ileo-anal pouch
This procedure is commonly called pouch surgery, but may also be described as IPAA (Ileo pouch- anal anastomosis) surgery.

Ileal Pouch following closure
of loop ileostomy

It generally requires two operations. In the first and main operation the surgeon removes the whole colon and the rectum, but leaves the anus. Then a pouch is made using the ileum (the lower end of the small intestine) and this is joined to the anus. Finally, a looped section of the small intestine is brought out onto the external wall of the abdomen through a temporary ileostomy. This allows the waste from digestion to be collected in a stoma bag until the newly-formed pouch has had a chance to heal – which generally takes about three months. A second operation will then go ahead to close the temporary ileostomy. The main advantage of a pouch is that faeces (stools) can be passed through the anus in the normal manner, although probably more frequently. Many people with a pouch have about 6 bowel movements a day, plus one or two more at night.

Colectomy with ileo-rectal
anastomosis

Colectomy with ileo-rectal anastomosis
This operation is much less common as it is only suitable for a small number of people with UC. In this the colon is removed, but instead of creating an ileostomy the surgeon joins the end of the small intestine directly to the rectum. This avoids the need for an ileostomy so may be helpful for people who do not want or could not cope with a stoma. It may also be an option for people unsuitable for pouch surgery. However, this operation is only recommended if there is little or no inflammation in the rectum and if there is no long-term risk of developing rectal cancer.

Colectomy with ileostomy
If you are having emergency surgery for Ulcerative Colitis you may have a colectomy with an ileostomy –

Colectomy with ileostomy

which usually allows for the possibility of pouch surgery at a later date. In this operation the surgeon removes the colon but leaves the rectum. Then, as in a proctocolectomy, the end of the small intestine is brought out through an ileostomy and an external bag is fitted onto this opening to collect the waste from digestion. This ileostomy may be temporary or can become permanent.
The upper end of the rectum is either closed or brought out to the surface to another temporary stoma. This is called a mucous fistula and is needed because the rectum may produce mucous for a while.
Depending on your individual medical condition, once you have recovered from the colectomy you may be able to have pouch surgery. Alternatively, you may decide on a permanent ileostomy.

Coming up in Part 3 - Risks, Advantages, Stomas and Laparoscopy