The main reason for undergoing surgery in ulcerative colitis is due to severe symptoms such as diarrhoea, a large amount of blood in the faeces, abdominal pain and weight loss. Although medication controls most symptoms, some patients will benefit from having surgery.
Surgery can involve two or three stage operations. If the patient is under-nourished and has severe symptoms and taking steroids or biological drugs, the first stage surgery involves removing ¾ of the colon and forming an ileostomy (a stoma formed from the end of the small bowel). Although this leaves a small part of the colon as well as the rectum behind, this surgery usually allows the patient ‘to get their life back,’ to return to work and, in most cases, to stop their steroids. This surgery, although major, can be performed using laparoscopic (keyhole) surgery.
The second operation entails removing the remaining colon and the rectum. In young and middle-aged patients, they will be offered “pouch” surgery which means that a new rectum is formed from the small bowel and joined to the remaining anus, thus allowing a patient to avoid a permanent stoma (or bag). Such surgery, however, is protected by a temporary stoma which can then be reversed at a third, smaller operation.
And finally, before undergoing any surgery, I will explain the procedure in great detail, including the benefits and any risks involved to allow you to make an informed decision. Sometimes, this decision could involve more than one or two consultations because it is important to understand fully the reasons for surgery and the impact it can have upon your life.