Early surgical intervention in ulcerative colitis

Abstract

Ulcerative colitis (UC), one of the major categories of inflammatory bowel disease (IBD), is characterised by chronic colonic mucosal inflammation of unknown aetiology. Unlike the other major form of IBD, Crohn’s disease (CD), UC is pathologically limited to the rectum and colon, facilitating definitive surgical therapy. Whereas the role of surgery in CD is primarily to treat complications of the disease process, surgery in UC is curative for the intestinal manifestations of the disease and nearly eliminates the risk of future malignancy. There exist three major indications for surgical intervention in UC. The first indication is for treatment of acute, medically unresponsive flares. The second is for poorly controlled symptomatic disease or to address intolerable treatment side effects. Lastly, surgery is performed for the possibility of malignancy after longstanding symptomatic or asymptomatic disease. Because there are indications for surgery, both early in the course of the disease and during the chronic disease phase, which may be asymptomatic, early curative surgical intervention is a reasonable alternative to prolonged medical management. Currently, surgical intervention is accomplished safely, with good functional results, and with a high degree of patient satisfaction. Historically, definitive surgical treatment of UC required removal of the colon, rectum, and anus and creation of a permanent ileostomy. Since the early 1980s, surgical therapy has evolved to removal of the entire colon and rectum followed by construction of an ileal pouch that is anastomosed to the anal canal. This procedure is known as a proctocolectomy and ileal pouch anal anastomosis (IPAA).1 IPAA avoids the need for a permanent ostomy and maintains the …