Principles of surgery

Removal of the entire large bowel, by definition, is curative in ulcerative colitis.

Alternatives include a panproctocolectomy and terminal ileostomy, and total colectomy and ileo-rectal anastomosis.

• panproctocolectomy and terminal ileostomy:
  • the whole colon is removed from the caecum to the anus
  • this procedure necessitates the construction of a permanent ileostomy
    
    
• total colectomy and ileo-rectal anastomosis:
  • in this procedure the colon is removed but the rectal stump is left in situ.
  • the terminal ileum may be re-anastomosed to it, either at the initial operation or as a secondary procedure.
  • it is possible to fashion the terminal ileum into a pouch - Park's pouch - to form a reservoir above the rectal stump. There is a risk recurrence of disease in the rectal stump. Thus the rectal mucosa is first stripped and the pouch anastomosed to the dentate line.

Reference

1. Ford AC, Moayyedi P, Hanauer SB; Ulcerative colitis. BMJ. 2013 Feb 5;346