Title: Ulcerative colitis - surgical approach
- Michał Drews, Jacek Hermann
- Review articles
- Polish Gastroenterology
- Start page:
- Final page:
- ulcerative colitis, indications for surgery, restorative proctocolectomy, complications, functional outcome
Ulcerative colitis (UC) is an idiopathic, nonspecific, diffuse inflammation of the rectal mucosa or rectal and colonic mucosa with chronic and relapsing course. Most patients with extensive inflammation ultimately requires surgery in spite of significant progress in the medical treatment of UC. Indications for surgery in UC are divided into emergency and elective. Severe complications of UC such as perforation of the colon and massive lower gastrointestinal tract bleeding, toxic megacolon and severe acute attack of UC unresponsive to medical treatment comprise the urgent indications. Elective indications consist of chronic, extensive, intractable UC, risk of neoplastic transformation, colorectal cancer and extra intestinal manifestations. The aim of the surgical treatment of UC is removing of the entire diseased large bowel mucosa and improvement of the quality of life through restoration of the digestive tract continuity and preservation of well functioning anal sphincter and as a result the natural way of defecation. Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) which fulfills the aforementioned requirements has become "gold standard" in the surgical treatment of UC. Multistage IPAA is a radical method of treatment for UC and life saving for patients who develop fulminant disease or malignant transformation. Although IPAA is associated with relatively high rate of complications such as pouchitis and fistulas most of which are curable and they do not threaten the lives of patients, the rate of pouch failure is low.