Surgery for Ulcerative Colitis

Ulcerative colitis (UC) is a chronic (long-term) inflammatory disease. It affects the lining of the large intestine, or colon, and rectum. You may need surgery if:

  • Other medical treatment, including medication, hasn’t helped. There may be a risk of cancer without surgery.
  • The colon has ruptured.
  • The patient has a severe, sudden onset of the disease.
  • There’s a lot of bleeding.
  • Treatment causes side effects severe enough to weaken the patient's health.
  • Toxic megacolon has set in. In this dangerous condition, the muscles of the large intestine are dilated, and the colon can rupture.

What Types of Surgery Can Treat Ulcerative Colitis?

There are different procedures. All are major surgery on your digestive system. Talk with your doctor about which one they recommend for you.

Hemicolectomy. This is an operation that removes part of your colon. There are two types, depending on where your problem area is:

  • Right hemicolectomy: Removes the right, or ascending, part of your colon. The surgeon may also take out some other areas, like your appendix and part or all of your middle large intestine. They'll connect what's left of your colon to your small intestine.
  • Left hemicolectomy: Removes the left, or descending, part of your colon. The surgeon will attach the right and middle parts to your rectum. This is the last place your bowel movements pass through on their way out.

Colectomy. This is surgery to remove the entire colon.

Proctocolectomy. This procedure removes both the colon and rectum.

Proctocolectomy is considered the standard treatment when surgery for ulcerative colitis is needed.

If the entire colon is removed, the surgeon may create an opening, or stoma, in the abdominal wall. The tip of the lower small intestine is brought through the stoma. An external bag, or pouch, is attached to the stoma. This is called a permanent ileostomy. Stools pass through this opening and collect in the pouch. The pouch must be worn at all times.

Another procedure is the pelvic pouch or ileal pouch anal anastomosis (IPAA). This procedure doesn't require a permanent stoma. This surgery is also called a restorative proctocolectomy. The patient is still able to eliminate stool through the anus. The colon and rectum are removed, and 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, you’d need 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 aren’t able to have IPAA. In this procedure, you’ll have 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 isn’t not the preferred surgical treatment for ulcerative patients. It has uncertain results and may result in the need for more surgery.

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Recovery

Hemicolectomy. Expect to stay in the hospital for at least a few days after surgery. But you could be there for up to a week. IV fluids will keep you hydrated right after the operation. You'll be on a liquid diet for 1-3 days. Medicine will help with pain, but you probably won’t want to do normal activities for a couple of weeks. If you have the open kind, it might take longer. Your doctor will probably tell you not to lift anything heavy for 6 weeks.

You should be able to eat and go to the bathroom as normal after you recover. But everyone heals at their own pace, so take it easy until you feel better. Ask your doctor what to expect.

Call your doctor if:

  • You have a fever of 100.4 F or higher.
  • Your cuts swell or leak blood, fluid, or pus.
  • Your pain gets worse.
  • You have a hard time breathing.
  • You can’t stop throwing up.
  • You still haven’t pooped 3 days after surgery.
  • There is blood in your stool.

What to Eat After Surgery

Ask your doctor when it’s safe to eat solid meals. It will take some time for your intestines and gut bacteria to digest food as normal. While you recover, your colon may also have trouble absorbing water. Make sure to drink 8-10 glasses of water or other fluid a day.

You might have:

To give your gut a rest, your doctor may have you follow a low-residue diet for about 4-6 weeks. This will make you have smaller bowel movements and go less often. It cuts out most fiber as well as some dairy. Some “low-residue” foods include:

  • Applesauce
  • Bananas
  • Bread or toast
  • Peanut butter
  • Yogurt
  • Potatoes
  • White rice
  • Cheese
  • Pasta
  • Tofu or meat that is easy to eat

Some foods you should avoid include:

  • Processed meat like hot dogs or sausage
  • Nuts
  • Beans, peas, lentils, and legumes

What Are the Benefits of Ulcerative Colitis Surgeries?

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

In addition, this surgery prevents colon cancer. Overall, an estimated 5% of ulcerative colitis patients will get cancer. Removing 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 affect only the lower colon and the rectum, the cancer risk without surgery could be up to 32 times the normal rate.

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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 within 5 years in about four out of every 100 patients with IPAA

If your pouch fails, you’ll need a permanent ileostomy.

A hemicolectomy has some of the same risks as other surgeries. Your doctor will give you anesthesia to put you to sleep. It’s safe for most people, but you could have a reaction that makes you feel sick for a few days. It’s rare, but some people may feel confused for a week or so.

You could also get blood clots in your legs or lungs. To lessen the chances of this, a doctor or nurse will get you to walk around every hour or so in your hospital room.

Other possible problems include:

Aftercare

Your doctor will want to see how you are doing after surgery. Talk to them about when you should come back. They may want you to visit within a couple of weeks. But your checkup schedule could be different, depending on why you needed the procedure.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on November 19, 2020

Sources

SOURCES:

National Digestive Diseases Information Clearinghouse: "Ulcerative Colitis."

Crohn's & Colitis Foundation of America: "Surgery for Ulcerative Colitis."

American Society of Colon & Rectal Surgeons: "Ulcerative Colitis."

Cedars-Sinai: “Hemicolectomy.”

Baylor College of Medicine: “Colon Resection.”

University of Chicago Medicine: “Colectomy.”

Health Direct (Australia): “Hemicolectomy.”

Mayo Clinic: “Colectomy,” “Right colectomy,” “Left colectomy.”

American College of Surgeons: “Colectomy.”

Northwestern Medicine: “Colectomy.”

Canadian Cancer Society: “Bowel Resection.”

University Hospitals Birmingham, NHS (U.K.): “Right Hemicolectomy -- Your operation explained.”

American Cancer Society: “Surgery for Colon Cancer.”

World Journal of Gastroenterology: “Laparoscopic vs open extended right hemicolectomy for colon cancer.”

Society of American Gastrointestinal and Endoscopic Surgeons: “Laparoscopic Colon Resection Surgery Patient Information From SAGES.”

American Society of Anesthesiologists: “Effects of Anesthesia.”

Canadian Society of Intestinal Research: "Low Residue Diet."

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