A colectomy is a surgical procedure to treat diseases of the colon or 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.

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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 procedures and what happens during each. We also look at when a person might need a colectomy, the risks of the procedures, 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, a person with severe UC or complications resulting from it 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 the rectum.

Surgeons can perform a proctocolectomy in one of two ways.

Open colectomy

This type of proctocolectomy involves making a lengthy vertical incision down the abdomen before performing the procedure.

Laparoscopic-assisted colectomy

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 people who have a laparoscopic-assisted procedure to recover more quickly and have less pain than those who undergo an open colectomy.

Modern medical treatments for UC have improved significantly.

According to Crohn’s & Colitis UK, 15% of people with UC may need a colectomy 10 years after receiving a diagnosis. However, this number is decreasing as scientists continue to develop better treatments.

The need for surgery varies depending on the severity of the disease and the area of the bowel it affects.

However, in general, 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.
  • About 5% of people with proctitis — inflammation of the lining of the rectum — may need a colectomy.

A person may need a colectomy for a number of reasons.

Many people with UC respond well to treatment with drugs, but in some cases, medications do not 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 case, a person may consider a colectomy.

In some cases, people with UC may need 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.

People with UC have a higher risk of developing colorectal cancer than the larger population. Inflammation in the colon can cause continuous cell turnover in the intestine, which increases the chances of cancer. Those who have had UC for 8–10 years 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.

Proctocolectomy with ileal pouch-anal anastomosis (IPAA)

This procedure, also called J-pouch surgery, 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 bowel function and allow stool to pass through the anus. Additionally, a person will not need a permanent external ostomy after this procedure.

Proctocolectomy with end ileostomy

This surgery involves removing the colon, rectum, and anus and creating 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. After this surgery, a person will wear an ostomy pouch outside their body at all times to collect waste.

A colectomy carries the same general risks as other surgical procedures that involve general anesthesia. There is also a risk of infection.

Other potential risks vary depending on the type of procedure and the person undergoing surgery.

A possible complication of IPAA surgery, or J-pouch surgery, is pouchitis. This occurs when the newly created internal pouch becomes inflamed. In one study involving 594 people who had IPAA surgery, almost half developed pouchitis.

The symptoms of pouchitis include:

  • fever
  • diarrhea
  • abdominal cramping
  • dehydration
  • 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.

Additionally, 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 most 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.

Removing the entire large intestine also eliminates the risk of colon cancer.

However, there are sometimes challenges after surgery. Adjusting to a stoma or pouch can be difficult, and some people may need time to get used to it. A person also may sometimes still feel the need to have a bowel movement after having surgery to create an ostomy. Doctors refer to these sensations as phantom rectum, and they typically subside over time.

Most people who have had surgery for UC feel that their overall quality of life is better after surgery than it was before.

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 creating 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, most people with UC report improvements in their quality of life after surgery.