Colitis and Surgery Part 3 - Risks, Advantages, Stomas and Laparoscopy

An ileostomy showing stoma opening

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.

Stomas

As described above, sometimes in surgery for Ulcerative Colitis the intestine is brought to the surface of the abdomen and an opening is made so that digestive waste products (liquid or faeces) drain into a bag, rather than through the anus. If the part of the intestine brought to the surface is the ileum (the lower end of the small intestine), this procedure, and the end of the intestine connected to the opening, is known as an ileostomy. If the large intestine or colon is brought to the surface and connected in a similar way, it is a colostomy. Both types of opening are also called stomas.

2 piece stoma bag
1 piece bags are available

Most stomas are about the size of a 50p piece and pinkish red in colour. Because the contents of the small bowel are liquid and might irritate the skin, an ileostomy usually has a short spout of tissue, about 2-3cm in length. Depending on the type of stoma bag used, ileostomy bags usually have to be emptied four to six times a day and changed about twice a week. Colostomies pass firmer stools, so colostomy bags are usually emptied slightly less frequently (about one to three times a day), and usually need to be changed each time.

Laparoscopy

Some of the operations outlined above, including pouch surgery, may now be carried out using laparoscopy (minimally invasive surgery). This is also known as ‘keyhole surgery’. Instead of making one large opening in the wall of the abdomen, the surgeon makes four or five small incisions (cuts) each only about 1cm (half an inch) long. Small tubes are passed through these incisions and a harmless gas is pumped in to inflate the abdomen slightly and give the surgeon more space. A laparoscope, a thin tube containing a light and a camera, is used to relay images of the inside of the abdomen to a television monitor in the operating theatre. Small surgical instruments can also be passed through the incisions and guided to the right place using the view from the laparoscope. If a section of the intestine needs to be removed, this can be done through a separate larger incision.

Laparoscopic operations tend to take longer than ‘open’ surgery, but can have a number of advantages, such as:

• less pain after the operation
• smaller scars
• faster recovery for example, being able to eat and drink more quickly after the operation
• reduced risk of a wound infection
• a shorter stay in hospital.

However, laparoscopic surgery may not be available in all centres and may not be appropriate for some procedures, particularly if you have already had abdominal surgery.

Are there risks to surgery?

Ulcerative Colitis is a very individual condition and the risks and benefits of different types of treatment will vary from person to person. Your IBD team should be able to help you weigh up what will be best for you.
Surgery for UC, like all surgery, will carry some general risks, including those linked to having a general anaesthetic. There is also a small risk that some operations may lead to complications such as infections.

Particular operations may have other risks: for example, occasionally an anastomosis (join) or an ileo-anal pouch can develops a leak and will need further surgery. Adhesions (sticky bands of material that form as part of the healing process) can twist the intestine. These usually settle down by themselves, but sometimes need dietary treatment. If you have a pouch there is also a risk that you may develop pouchitis (inflammation of the pouch), which may need treatment with antibiotics. Your surgical team will be able to tell you more about any possible complications, how likely they are for the operation planned for you, and how they are usually treated.

What are the advantages of surgery?

Unlike Crohn’s Disease, which can recur after surgery, Ulcerative Colitis cannot recur once the colon has been removed, and so is ‘cured’ by surgery. This should mean:

• relief from pain
• relief from symptoms such as urgency and diarrhoea
• being able to stop taking drugs which may be causing side effects
• feeling able to lead a fuller life, for example being able to leave the house in a more relaxed frame of mind.

However, as above, complications do sometimes develop, and it will take time to get used to having a pouch or an ileostomy.

Coming up in Part 4 - What to expect - Before and After Surgery