When do I consider surgery?
In a majority of cases, UC can be managed medically, but there are certain situations when surgery is indicated. Historically, 30-40% of all UC patients eventually underwent removal of the colon, or colectomy.
The following are reasons for colectomy:
1) Medically refractory disease - Flares are either frequent or continuous despite maximal medical therapy.
2) Corticosteroid dependence - When continous steroids are required to prevent flares.
3) Inability to tolerate medical therapy - If the medications cause side effects that are not tolerable or allergic reactions.
4) Dysplasia (pre-cancer) or cancer - Although not all dysplasia requires surgery, some do and all cancer does.
5) Prophylaxis against cancer - For those who do not want to take the chance of getting cancer and do not want to undergo frequent colonoscopy to look for dysplasia an cancer
6) Avoid chronic medical therapy - For those who do not want to take chronic medication.