Ulcerative colitis is a medical condition where the lining of the large intestine becomes inflamed. Patients present with bloody diarrhoea and require medications to reduce the inflammation. Surgery is required when medical therapy fails to control the disease or when the entire colon and rectum must be removed.
The cause of ulcerative colitis is unclear but there is probably a combination of environmental and genetic factors which affect disease progression. Many patients are diagnosed as young adults. Colonoscopies show that the lining of the rectum and variable lengths of colonic mucosa extending above the rectum are inflamed. The friable and bleeding mucosa is ulcerated. The diagnosis is confirmed with biopsies.
The initial management is with steroids and anti-inflammatory medications. These may be administered orally, rectally or through infusions into the vein. These treatments are effective in most. Occasionally, flares of disease cannot be controlled with first line therapies and gastroenterologists then administer second line therapies like Infliximab which control the inflammation.
In some patients medical therapy cannot control the disease and the bloody diarrhoea continues with significant loss of weight and reducing blood counts. For these sick patients, acute surgery is sometimes required. A subtotal colectomy is performed when the disease is not responding to treatment acutely. Most of the colon is removed, the rectum is left and rested in the pelvis and a temporary ileostomy or intestinal bag is brought out through the abdominal wall. This surgery prevent further diarrhoea and allows the patient to recover condition.
For patients who have managed their ulcerative colitis for a number of years, surgery is sometimes required to remove all of the disease colon and rectum. The small bowel is joined to the anus is such a way that good continence is maintained. This surgery is caused a proctocolectomy with ileoanal pouch construction. The surgery is usually completed in steps spread out over several months.
Patients who complete all the steps of “pouch” surgery are cured of their ulcerative colitis and usually report good function from the operation. There are often 5 stools per day, continence and an ability to return to work and exercise. Both the acute, emergency surgery and the elective pouch surgery for ulcerative colitis can be performed using “keyhole” techniques. That is using laparoscopy or robotic approaches to reduce the size of the incisions and accelerate return to work.