Surgical management of ulcerative colitis

Surgery is required in 20% of patients with ulcerative colitis.

The quality of life after surgery is excellent and a colectomy eliminates the need for continuous medical therapy and the need for cancer surveillance.

Most extraintestinal symptoms of UC will resolve after a colectomy. The exceptions to this are sclerosing cholangitis and arthritis. Note also that growth retardation is reversed if a colectomy is performed before puberty.

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPPA) which conserves the anal route of defaecation (without a stoma) has become the recent gold standard for surgery in patients with UC (1).

Be aware that there may be an increased likelihood of needing surgery for people with any of the following (2):

• stool frequency more than 8 per day
• pyrexia
• tachycardia
• an abdominal X-ray showing colonic dilatation
• low albumin, low haemoglobin, high platelet count or C-reactive protein (CRP) above 45 mg/litre (bear in mind that normal values may be different in pregnant women)

Reference:

• (1) Travis SPL et al. European evidence-based Consensus on the diagnosis and management of ulcerative colitis: Current management. Journal of Crohn's and Colitis (2008) 2, 24-62
• (2)NICE (May 2019). Ulcerative colitis Management in adults, children and young people