Surgical treatment of ulcerative colitis

Abstract

Definitive surgical therapy for patients with medically refractory ulcerative colitis (UC) entails the complete removal of the colon and rectum. Although this does not address the underlying pathogenesis of the disease, it removes the principal target organ and, when followed by the creation of a neorectum, allows the majority of children and adolescents to achieve a very high quality of life including essentially normal bowel function, growth, and development, usually without the need for maintenance medical therapy. It also substantially diminishes the risk of malignant degeneration. Proctocolectomy with ileal J-pouch reconstruction has become the standard of care, though there remains considerable variation in approach, including the increasing application of minimally invasive techniques and other technological advances, which have improved recovery, cosmesis, and function. There is increasing emphasis on achieving normal bowel function, minimizing complications, and improving the overall quality of life. Nevertheless, despite these rather dramatic technical advances, fewer postoperative complications, and overall excellent functional outcomes, the surgical therapy of UC remains less than ideal, principally due to the ongoing and poorly understood problem of chronic and recurrent pouchitis, misdiagnosed Crohn disease, and, in a few cases, pouch failure necessitating pouch removal and permanent ileostomy.