Surgeries for Ulcerative Colitis

Ileal pouch-anal anastomosis: Since ulcerative colitis is limited to the large intestine, the standard surgery is total proctocolectomy surgery in which the large intestine is totally removed. After this point, the small intestine is given a J shape (J pouch) and connected to the rectal region in patients whose rectal regions are not affected by the disease. The goal of creating a pouch is to allow the intestinal content to wait here for a while, providing the patient to go to the toilet less frequently. This operation is called J pouch-anal anastomosis. This is the most commonly used ulcerative colitis surgery in the world. This anastomosis performed at the very low level poses a high risk in terms of the leak (the risk of a leak is about 10%). During the healing period, we do not want stool to pass through this region, so an opening (stoma) that connects a little more upper part of the small intestine to the abdomen is created.

Ileorectal anastomosis: Although the disease almost always begins from the last part of the large intestine, in some cases, the last 15cm of the large intestine, called the rectum, can be intact. In such a case, other parts of the large intestine are removed without removing the last 15 cm part and the small intestine is connected to this remaining part.

Advantage

• • This connection poses a relatively low risk in terms of a leak.
• Since the surgery is not performed adjacently to the urinary and reproductive tracts, the complications associated with these organs almost never arise.
• No complication associated with pouch arises since ileal pouch is not required.

Disadvantage

• Since the entire large intestine is not removed, the disease may recur in this region in the later periods.
• Within 10 years, 50% of the patients require a second surgery in which the remaining large intestine is removed.
• End ileostomy: In some cases, the muscles that allow us to control bowel movements become dysfunctional by being affected by the disease. In such a case, connecting the small intestine to the rectum leads to a very uncomfortable situation for the patient. Therefore, ileostomy procedure (small intestine is diverted through an opening in the abdomen) is performed. Although it is a very low-risk surgery compared to other surgeries, ileostomy is permanent for life.

In emergency surgeriesIn cases where the general condition of the patient is very poor and posing a high threat to life, performing the above-mentioned surgeries has very high risk. Since these patients usually use high-dose ulcerative colitis drugs, the healing functions are impaired, resulting in increased susceptibility to infections. At this point, the shortest and the most risk-free surgeries that will save the patient’s life are performed. The above-mentioned surgeries can be performed in a second session after the patient overcomes the life-threatening situation.

The European Crohn´s and Colitis Organisation (ECCO) classified ulcerative colitis surgeries as featured surgeries and prohibited them to be performed by non-experienced surgeons. The centers carrying out at least 10 ulcerative colitis surgeries per year have been accepted as the reference centers, and it has been recommended that these surgeries performed by surgeons working at these centers. Since Prof. Samet Yardimci, MD has become a general surgeon, he worked at Turkish High Specialty Training and Research Hospital as well as Marmara University, which are accepted to be reference centers for ulcerative colitis, and was involved in the surgical treatment of numerous patients with ulcerative colitis.