What about surgery for ulcerative colitis?
Removal of the diseased colon is usually reserved for patients who have failed to respond to conventional medical therapy, or who develop cancer or dysplasia (pre-cancer). The standard procedure is a total colectomy (removal of the entire colon) and either placing the small bowel draining to the skin (ileostomy), or formation of an internal pouch of small bowel (ileal-pouch anal anstamosis (IPAA). The surgery is relatively safe, and can be done by the keyhole method (laparoscopically). The early complication rate is less than 10%; the complications that do occur include infections, failure of the pouch and the usual risks of any major surgery, such as blood clots. If an IPAA is formed, the entire procedure may be performed in one operation or in two, depending on the severity of the disease during the initial surgery. Patients who have an IPAA typically have 5-7 stools per day, which is usually an improvement on their symptoms before surgery. Half the patients with IPAA will be on medicines to help regulate their bowel movements. Approximately 10% of patients with have frequent episodes of incontinence. About 15% of patients develop chronic inflammation in the new pouch (chronic pouchitis), which is diagnosed and treated in the same manner as ulcerative colitis. Other long-term complications of an IPAA include irritable pouch syndrome, cuffitis, pouch cancer and reduced fertility (3-fold increased risk).