[Surgery for ulcerative colitis]

Surgical therapy for ulcerative colitis (UC) is affected by medical therapy for the condition. However, that therapy has changed greatly over the past 10 years. Furthermore, there has been a sharp increase in the number of patients with cancer/dysplasia with indications for surgery. The increase in the choices available for effective medical treatment has led to changes in therapeutic medicine. When such treatments are ineffective, emergency surgery is performed, and thus emergency surgery cases are also showing an increasing trend. Patients with indications for surgery are becoming significantly older, and it is not unusual to perform surgery on those more than 70 years of age. Unfortunately, the prognosis is poor in elderly patients who undergo emergency surgery, and thus the timing of surgery is especially important. The primary surgical procedure used for UC is restorative proctocolectomy with an ileal pouch-anal anastomosis or anal-canal anastomosis. Consensus has been reached that anal anastomosis is performed for patients with cancer, while anal-canal anastomosis is performed in older patients. Pouchitis is a frequently reported postoperative complication, although the number of cases of postoperative aggravation of gastroduodenal and small intestinal lesions has been reported to be increasing. Notably, hemorrhaging can be fatal, as hemostasis is sometimes difficult to achieve.