Surgical options in ulcerative colitis

Five operative options are now available for treatment of ulcerative colitis: (1) proctocolectomy with ileostomy, (2) abdominal colectomy with ileostomy and retention of the rectum, (3) abdominal colectomy with ileorectal anastomosis, (4) proctocolectomy with creation of a continent stoma or conversion of a standard ileostomy after proctocolectomy to a continent stoma, and (5) restorative proctocolectomy. Each procedure has advantages and disadvantages. With careful assessment, the specific needs of each patient can best be met. In many cases a permanent stoma can be avoided. The newer procedures have not been used long enough for long-term effects to be known, and they must be offered with reservation and then only to well-informed, stable, and relatively fit and cooperative patients.