WHAT IS ULCERATIVE COLITIS?
Ulcerative colitis is an inflammatory disease that affects your colon and rectum, and treatment usually begins with medications to control inflammation and other symptoms. However, 23 percent to 45 percent of people with ulcerative colitis will need surgery.
WHEN IS SURGERY THE BEST CHOICE?
For some people, surgery could be necessary sooner rather than later — possibly even during a first attack, especially with the onset of sudden and severe symptoms. If an ulcerative colitis flare causes serious symptoms such as severe bleeding or a rapid enlargement of the colon called toxic megacolon, emergency surgery may be required. About 15 percent of people with ulcerative colitis may experience this type of flare.
A complication from ulcerative colitis, such as colon cancer, is the second most common reason for surgery. Removing the colon and rectum is usually recommended if you develop cell changes called dysplasia. After a number of years of living with ulcerative colitis, regular screenings to look for early signs of colon cancer are suggested.
Surgery may also be recommended if your symptoms aren’t well-controlled and are affecting your quality of life
WHAT ARE THE TYPES OF SURGERY?
There are two types:
Proctocolectomy: Historically, the standard operation for ulcerative colitis has been removal of the entire colon, rectum, and anus. This operation is called a proctocolectomy. It cures the disease and removes all risk of developing cancer in the colon or rectum. However, this operation requires a permanent ileostomy.
Some patients may be treated by removal of the colon, while leaving behind the rectum and anus. The small bowel can then be re-connected to the rectum and patients can pass motion normally. However, there is an increased risk of ongoing disease in the rectum, increased stool frequency, and cancer in the retained rectum.
Ileoanal Pouch Procedure: The currently preferred operation by colorectal surgeons is an ileoanal pouch procedure. This is the newest alternative. This procedure removes all of the colon and rectum, but preserves the anal canal. The rectum is replaced with small bowel, which is refashioned to form a small pouch. A temporary ileostomy is created while the pouch is allowed to heal, but this is closed in a few months later. The pouch acts as a reservoir to help decrease the stool frequency. This maintains a normal route of defecation, but most patients experience five to ten bowel movements per day. Patients can develop inflammation of the pouch, which requires antibiotic treatment. In a small percentage of patient, the pouch fails to function properly and may have to be removed. If the pouch is removed, a permanent ileostomy will be necessary.
It is important to recognise that none of these alternatives makes a patient with ulcerative colitis normal. Each alternative has perceivable advantages and disadvantages, which must be carefully understood by the patient prior to selecting the operation which will allow the patient to pursue the highest quality of life.
WHAT TO DO AFTER SURGERY FOR ULCERATIVE COLITIS?
You can expect to be in the hospital for up to a week after surgery. Over time you should be able to return to all of the activities you enjoyed before, and you may even be able to try other activities that having ulcerative colitis might have kept you from pursuing. The biggest adjustment after surgery for ulcerative colitis is more frequent bowel movements — about four to eight times per day, Ullman says.
If you have the restorative procedure, your surgeon will create a pouch to hold stool before you have a bowel movement through your rectum. Inflammation of this pouch, called pouchitis, is the most frequent complication after surgery. Symptoms include cramps, diarrhoea, and fever. About 50 percent of people develop pouchitis in the first few years, but antibiotics usually clear it up. One of the most important things to know about surgery for ulcerative colitis is that once your colon and rectum have been removed, there’s no place left for ulcerative colitis to occur.
WHY KIMS?
KIMS, one of the premier gastroenterology hospitals in Hyderabad, offers specialized treatment for ulcerative colitis in Hyderabad. Our ulcerative colitis treatment specialist in Hyderabad ensures that patients understand all aspects of surgery and make the best choice available so that their lives are least impacted by ulcerative colitis.