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March 2011 IBD Newsletter >>
Restorative Proctocolectomy for Ulcerative Colitis
Restorative proctocolectomy has allowed patients with conditions such as ulcerative colitis to avoid living with a permanent ileostomy and external appliance after colectomy. Considered the “gold standard” for patients undergoing colon removal, restorative proctocolectomy has revolutionized the surgical management of ulcerative colitis and has evolved to include minimally invasive techniques.
How do we evaluate patients for surgical management of ulcerative colitis?
The majority of patients presenting for surgical management of ulcerative colitis are managed by a gastroenterologist or primary care physician. The presentation of patients with steroid dependency (greater than 1-2 years of steroid treatment) is still one of the principle indications for surgery. Currently, many patients with ulcerative colitis are also managed with other immune modulating drugs that may limit acute flares and disease activity, but may not prevent surgical management at a later interval in the disease course. In addition, screening colonoscopies are still advised to be performed at yearly intervals to assess any changes.
What are the required tests for consideration for surgical management of ulcerative colitis via restorative proctocolectomy?
There are relatively few additional tests to be performed for patients with ulcerative colitis provided a recent colonoscopy has been performed. It’s essential that the diagnosis of Crohn’s disease be excluded. The success of restorative proctocolectomy is determined in large part by maintenance of continence. In the case of patients in otherwise good medical condition but over 60 years of age, the quality of sphincter function may need to be preoperatively confirmed. This is especially true in patients with a past history of significant obstetrical related trauma to the sphincter complex.
What are the indications for restorative proctocolectomy?
Most ileal pouch recipients have a history of ulcerative colitis that has failed to respond to more conservative treatments. Others include:
Why is Minimally Invasive Surgery (MIS) the gold standard for restorative proctocolectomy?
Restorative proctocolectomy is one of the most extensive and complex gastrointestinal procedures used today. The procedure itself allows for a total abdominal proctocolectomy and ileal pouch reconstruction through an incision that is often less than 6-7 cm in size. It provides excellent quality of life and functional results in the vast majority of patients undergoing the procedure, which is reflected in a low stool evacuation frequency and good continence with improvements in quality of life scores.
For more information on restorative proctocolectomy, or the surgical treatment of other diseases of the colon and rectum, please click here.