Surgical therapy in ulcerative colitis

Ulcerative colitis is cured if the colon and rectum are removed. The total proctocolectomy provides the cure, but the ileostomy is not well accepted by patients. Thus, alternatives that provide continence but have an increased morbidity have been introduced. The continent ileostomy (Koch pouch) has a valve created in an ileal pouch which provides continence. Intubation with a catheter is necessary and a flat ostomy is present. A colectomy with ileoproctostomy can be used to salvage the sphincter. Unfortunately, the diseased rectum is spared with its potential for progressive symptoms and cancer. The newest technique is also the most morbid. This procedure requires total colectomy, stripping of the rectal mucosa, formation of an ileal pouch, anastomosis of the pouch to the anus, and placement of a diverting ileostomy to allow complete healing without passage of stool. The failure rate is five to ten per cent, but most young people opt to save the sphincter and preserve their body image.