If I have surgery for UC, can I have only part of my colon taken out?
YS wrote into the blog asking about the surgical options for UC:
"My wife is suffering from ulcerative colitis since 1990 and has been taking sulfasalazine and steroid treatment with local enema but now she is not responding to the treatment and relapses are very early and frequent with daily motions exceed 30 to 35 per day with bleeding per rectum and abdominal pain. What are the prospects of surgery like left hemicolectomy with colorectal anastomosis?"
Indications for surgery in UC include:
1) Failure of maximal medical therapy to control disease
2) Colon malignancy
3) Fulminant colitis with complications (ie; diseased colon wall that breaks open)
4) Massive gastrointestinal bleeding
With regard to surgical procedures, the preferred surgery at the current time is total abdominal proctocolectomy (removal entire colon and rectum) with either an ileostomy (external ostomy bag) or ileoanal pouch (internal pouch made from small bowel). The decision to have a permanent ostomy versus a pouch depends on patient age, weight, and technical factors. Y.S. queried about the possibility of only removing only the diseased portion or part of the colon. This entails surgeries called subtotal colectomies or an ileorectal anastomosis (connection of the small bowel to the rectum). Surgical experience has shown that removal of only part of the colon is unsuccessful because the rectum is almost uniformly involved in UC. Diseased rectum is not distensable and difficult to connect surgically to additional segments of colon and bowel. Also, the natural history of UC has shown that disease inevitably returns post-operatively to the unresected portion of the colon. Lastly, leaving in even a small portion of the colon does not reduce the future of risk of colon cancer in UC. As such, total proctocolectomy remains the favored surgical option at this time.
For more information about surgical options for UC, these websites may be of interest:
CCFA website - http://www.ccfa.org/info/surgery/surgeryuc
Up To Date - http://patients.uptodate.com/topic.asp?file=digestiv/10295