A colectomy is a surgical procedure that treats diseases of the colon, which is part of the large intestine. During a colectomy, surgeons remove a portion of the colon. Ulcerative colitis (UC) is a disease that may require treatment with a colectomy.
This procedure can improve the quality of life for people with UC, but it does carry the risk of complications.
In this article, we explain the types of colectomy procedure and what happens during them. We also look at when a person might need a colectomy, the risks of the procedure, and a person’s outlook afterward.
UC causes ulceration and inflammation in the inner lining of the large intestine. As the colon becomes inflamed, it is less able to hold water and waste. As a result, a person may experience more frequent bowel movements and diarrhea.
In some cases, those with severe UC or resulting complications may need to have a colectomy, which involves the surgical removal of the colon.
The typical surgical procedure for UC is a type of colectomy known as a proctocolectomy. During this procedure, surgeons remove both the colon and rectum.
Surgeons can perform a proctocolectomy in one of two ways:
This type of proctocolectomy involves an operation with a lengthy vertical incision down the abdomen.
Surgeons perform this type of proctocolectomy by making only small incisions, through which they insert a camera to see the colon during surgery. In many cases, the small incisions allow those who have a laparoscopic-assisted procedure to recover quicker and have less pain than those who undergo an open colectomy.
Modern medical treatments for UC have improved significantly.
According to estimates, 15 in 100 people with UC may require a colectomy 10 years after receiving a diagnosis. However, this number is reducing, as scientists are continually developing better treatments.
The need for surgery varies depending on the severity of the disease and which area of the bowel it affects.
In general, though, 10 years after diagnosis:
- About 19% of people who have extensive colitis may require a colectomy.
- Close to 8% of those with left-sided colitis may need a colectomy.
- Approximately 5% of people with proctitis, which is inflammation of the lining of the rectum, may need a colectomy.
A person may need a colectomy for a number of reasons. These include:
- Lack of response to long-term medical treatment: Many people with UC respond well to treatment with drugs, but, in some cases, medications fail to control inflammation of the colon. If medication is ineffective, a person may experience continual flare-ups and discomfort, which can reduce their quality of life. In this instance, an individual may consider a colectomy.
- An emergency: In some cases, people with UC may require emergency surgery. For instance, a perforation of the wall of the colon would require surgery. People with severe UC symptoms that do not resolve with hospital treatment may also need a colectomy. These symptoms may include dehydration, severe diarrhea with bleeding, and fever.
- Cancer: People with UC have a higher risk of developing colorectal cancer compared with the general population. Inflammation in the colon can cause continuous cell turnover in the intestine, which increases the chances of cancer. Those with an 8–10-year history of UC have an increased risk of bowel cancer. Healthcare professionals may recommend regular colonoscopies to determine whether cancer has developed. If cancer is present, it may be necessary to consider a colectomy.
There are two forms of proctocolectomy that surgeons typically perform for people with UC.
A proctocolectomy with ileal pouch-anal anastomosis (IPAA)
This procedure is also called J-pouch surgery, and it is the most common surgery that people with UC undergo. It involves removing the colon and rectum and creating an internal pouch.
People with UC and healthcare professionals often prefer this surgery, as it can restore the function of the bowels and allow stool to pass through the anus. There is also no need for an external ostomy on a permanent basis.
A proctocolectomy with end ileostomy
This surgery involves the removal of the colon, rectum, and anus, alongside the creation of an external ostomy where waste exits the body. During this procedure, a surgeon will create a small hole called a stoma in the abdomen to allow waste to exit. Following this surgery, the person will wear an ostomy pouch outside the body at all times to collect waste.
The risks vary depending on the type of procedure and the individual undergoing surgery. A colectomy carries the same general risks as other surgical procedures that involve general anesthesia. There is also a risk of infection.
A possible specific complication of IPAA surgery, or J-pouch surgery, is pouchitis. This complication occurs when the newly created internal pouch becomes inflamed.
The symptoms of pouchitis include:
- abdominal cramping
- joint pain
- increased bowel movements
Doctors may prescribe antibiotics to treat pouchitis.
An IPAA procedure can also carry unique risks. For instance, infection from surgery at the site of the stoma is possible.
Also, if no waste exits the stoma for 4–6 hours, a blockage may occur, causing nausea and cramping.
Other complications that require treatment relate to the stoma. A stoma that protrudes more than usual outside the abdominal wall is called a prolapse, while a stoma that retracts farther inside the body than it should is called a retraction.
UC cannot return after the removal of the large intestine. For the majority of people, this means relief from symptoms such as urgency, diarrhea, and pain. It also eliminates the need for medications that may cause undesirable side effects.
If surgeons remove the entire large intestine, the risk of colon cancer also no longer exists.
However, there are sometimes challenges following surgery. Adjusting to a stoma or pouch can be difficult, and some people may take time to get used to it. A person may sometimes still feel the need to have a bowel movement following surgery to create an ostomy. Doctors refer to these sensations as phantom rectum, and they typically subside over time.
People with UC who have not responded to other treatments may need a colectomy, as may those who experience an emergency complication or cancer.
Surgery involves the creation of either an internal pouch called a J-pouch or an external stoma and pouch called an ostomy. Although these procedures involve some level of risk, the majority of people with UC report improvements to their quality of life following surgery.