Current surgical therapy for mucosal ulcerative colitis
- 1 June 1994
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 37 (6), 610-624
- https://doi.org/10.1007/bf02051000
Abstract
PURPOSE: There are numerous surgical options for the treatment of mucosal ulcerative colitis. METHODS: This article reviews the currently available options for the treatment of mucosal ulcerative colitis. Separate discussions will explore both the options in the emergency and elective settings. RESULTS: Patients with mucosal ulcerative colitis may undergo surgery either as an emergency or in the elective setting. Emergency surgery is usually performed for one of the life-threatening complications of ulcerative colitis: fulminant colitis, toxic megacolon, or massive hemorrhage. The most commonly performed procedure under these conditions is a subtotal colectomy with end ileostomy. The rectal stump may be handled in a variety of ways. This procedure avoids proctectomy or anastomosis. Thus, patients will still have all necessary anatomic structures to allow for any of the definitive elective procedures. Elective surgery is performed for intractable disease, complications of medical therapy, dysplasia, or, occasionally, extraintestinal manifestations. In the elective setting, a definitive operation can be done to remove most or all of the disease-bearing colorectum and leave the patient with a means to control fecal elimination. Total abdominal colectomy with ileorectal anastomosis leaves the patient with diseased bowel but obviates the need for pelvic dissection. Although total proctocolectomy removes all potentially diseased mucosa, these patients have a permanent ileostomy. The stoma can either be a standard Brooke's ileostomy or a continent Kock pouch. The most common definitive procedure currently performed is the near-total proctocolectomy with ileal pouch-anal anastomosis. This option can be completed either with a rectal mucosectomy and handsewn anastomosis or with a double-stapled anastomosis, preserving the anal transition zone. This procedure is successful in eradicating almost all diseased mucosa while allowing the patient per anal defecation. Bowel movement frequency, degree of anal continence, and return to social and professional commitments have met with a great deal of satisfaction in most patients. A newer alternative to this procedure employs laparoscopy to facilitate a smaller incision. A one-stage procedure which omits the protective ileostomy and thus saves the patient one operation has also been used with some success in selected cases. CONCLUSION: There are several surgical options for the treatment of mucosal ulcerative colitis. Each one has a role and should be discussed with the patient.Keywords
This publication has 77 references indexed in Scilit:
- Continuing Evolution of the Pelvic Pouch ProcedureAnnals of Surgery, 1992
- Laparoscopic total abdominal colectomyDiseases of the Colon & Rectum, 1992
- Laparoscopic Total Proctocolectomy with Creation of Ileostomy for Ulcerative Colitis: Report of Two CasesJournal of Laparoendoscopic Surgery, 1992
- Complications associated with heal pouch‐anal anastomosisWorld Journal of Surgery, 1991
- Subtotal colectomy for ulcerative colitisDiseases of the Colon & Rectum, 1991
- Ileal pouch-anal anastomosis without ileostomyDiseases of the Colon & Rectum, 1991
- Small Intestinal Obstruction Complicating Ileal Pouch-anal AnastomosisAnnals of Surgery, 1989
- Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: A pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection with mucosal proctectomy and endo-anal anastomosisBritish Journal of Surgery, 1987
- Ileal Pouch-Anal AnastomosisAnnals of Surgery, 1986
- Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitisBritish Journal of Surgery, 1978