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Surgery for Ulcerative Colitis

What Types of Surgery Can Treat Ulcerative Colitis? continued...

Another procedure is the pelvic pouch or ileal pouch anal anastomosis (IPAA). This is a procedure that does not require a permanent stoma. This surgery is also called a restorative proctocolectomy. The patient is still able to eliminate stool through the anus. In this procedure, the colon and rectum are removed. Then the small intestine is used to form an internal pouch or reservoir -- called a J-pouch -- that will serve as a new rectum. This pouch is connected to the anus. This procedure is frequently done in two operations. In between the operations the patient needs a temporary ileostomy.

The continent ileostomy, or Kock pouch, is an option for people who would like their ileostomy converted to an internal pouch. It's also an option for people who do not qualify for the IPAA procedure. In this procedure, there is a stoma but no bag. The colon and rectum are removed, and an internal reservoir is created from the small intestine. An opening is made in the abdominal wall, and the reservoir is then joined to the skin with a nipple valve. To drain the pouch, the patient inserts a catheter through the valve into the internal reservoir. This procedure, however, is not the preferred surgical treatment for ulcerative patients. That's because of its uncertain results and the potential need for additional surgery.

What Are the Benefits of Ulcerative Colitis Surgeries?

If the entire colon is removed, ulcerative colitis is cured. This should put an end to the diarrhea, abdominal pains, anemia, and other symptoms.

In addition, the surgical procedures prevent colon cancer. Overall, an estimated 5% of ulcerative colitis patients will develop cancer. The elimination of the colon cancer threat is especially significant for people who have ulcerative colitis that affects the entire colon. In these cases, as opposed to cases of ulcerative colitis that affects only the lower colon and the rectum, the cancer risk without surgery could be up to 32 times the normal rate.

What Are the Complications of Ulcerative Colitis Surgeries?

Complications from ileoanal anastomosis may include:

  • More frequent and more watery bowel movements
  • Inflammation of the pouch (pouchitis)
  • Blockage of the intestine (bowel obstruction) from internal scar tissue, called adhesions, caused by surgery
  • Pouch failure, which happens in about 8% to 10% of patients with IPAA

If the pouch fails, the patient will need to have a permanent ileostomy.

WebMD Medical Reference

Reviewed by Kimball Johnson, MD on August 03, 2012

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