Surgery for ulcerative colitis: before, during and after

November 8, 2022


cirugia colitis ulcerosa

Physicians have an extensive therapeutic arsenal for treating patients with ulcerative colitis. Available drugs keep the disease inactive or in remission in most cases. Despite this between 25% and 40% of patients with ulcerative colitis will need surgical treatment at some point in their illness1.

Unlike Crohn’s Disease2, surgery in ulcerative colitis is curative. The fact is that, by affecting the rectum and the colon, its removal implies the total healing of the patient.

In particular, surgery is indicated3 when the pharmacological treatment has not controlled the symptoms of ulcerative colitis; when complications such as stenosis (narrowing or reduction of the internal diameter of the intestine), perforation, severe bleeding, abscesses or fistulization occur; when premalignant or carcinogenic lesions develop;  or when perianal disease occurs and drainage surgery is necessary, derivative colostomies to isolate fistulas from passing stool or radical protections in advanced cases.

Preparation of the patient before surgery

The surgeon and the gastroenterologist study the progress of ulcerative colitis in the patient to determine the extent and severity of the symptoms. Afterwards, they inform him about the technique best suited to his situation and the benefits, complications and risks associated with it4.

Before surgery5, the patient will undergo a preoperative study consisting of: blood and urine analysis, chest x-ray and electrocardiogram. In addition, it is very important for the patient to be in good general condition and to discontinue the treatment he is taking (corticosteroids, immunosuppressants or biologic therapy, granulocyte apheresis…), if any.

Two days before the intervention, the patient should follow a liquid diet so, with the help of an intestinal preparation, the intestine is emptied of waste or traces of feces.

Surgical interventions in the treatment of ulcerative colitis

The gastroenterologist and surgeon may choose from a variety of surgical techniques to treat ulcerative colitis6. Among the most common ones stand out: the total proctocolectomy with ileostomy or with ileoanal reservoir. It is also very common to perform a total colectomy with ileorectal anastomosis, and subtotal colectomy with ileostomy and rectosgmoid mucous fistula.

When a total proctocolectomy is performed, the entire rectum and colon are resected. If it is decided to perform a total proctocolectomy with ileostomy, an opening or hole is made that connects the ileum to the outside (ileostomy) to remove the intestinal waste in a bag (ostomy).

In the event that medical professionals choose to perform a restorative proctocolectomy or ileoanal reservoir, an internal reservoir or pouch is created with part of the small intestine (ileum) that will be attached to the anus and function as a new rectum.

The technique known as total colectomy with ileorectal anastomosis consists in resecting the entire colon and joining (anastomosis) the ileum with the rectum. For its part, in the subtotal colectomy with ileostomy and rectosgmoid mucous fistula, only the affected areas of the colon are resected and an ileostomy is performed. If the sigma (the end of the colon) is not affected, it is left intact and communicates with the outside through the anus or through a mucous fistula performed on the abdominal wall for the secretions to come out.

What happens after surgery in ulcerative colitis?

After the surgery in ulcerative colitis, the patient’s recovery comes.  Initially, he will not be able to ingest any type of food. He will only receive nutrients through parenteral nutrition, intravenously. Once the intestinal movement is restored, he can gradually begin to swallow liquids and subsequently solids.

Furthermore, it is common for the patient to evacuate traces of blood, mucus and/or feces through the rectum, sometimes, without being able to help it. That is called rectal incontinence. If the rectum is intact, he will not experience any pain during evacuation. The frequency of these secretions will decrease over time.

In the case of an ostomy, the patient should begin to get used to his new situation as soon as possible. His intestinal function will be altered, his body image will change and he will have a stoma. During his hospital stay, healthcare professionals will help the patient and his family adapt, offering them all the advice and information they need.

However, given the changes in the patient’s quality of life and the complications usually associated after this surgery (cross with new article commenting on this topic), it is always reserved as the last alternative and when the rest of available treatments have not been effective in the control of ulcerative colitis.

  2. Ulcerative colitis and Crohn similarities – Adacyte
  6. What is ulcerative colitis? – Adacyte

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