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Surgery in Ulcerative Colitis
Discuss the indications for surgery in UC?
Discuss the types of surgery in UC?
Since UC only affects large bowel, a proctocolectomy is curative. Further ileal pouch surgery allows patients to live without ileostomy. Surgical options are:
Total colectomy with ileostomy is the procedure of choice in emergency situations. Subsequent proctectomy with ileal pouch-anal anastomosis can be done electively. IPAA has high complication rates when performed on patients with acute/toxic colitis.
Further, ileostomy may also be needed if IPAA is not technically possible or has failed. Most patients’ small bowel will extend the necessary length, and a variety of techniques are employed to make the ileum reach the anal canal. In the unusual event that the small bowel does not reach, a permanent ileostomy may be needed.
Ileorectal/IPDRA anastomosis is technically easier surgery than IPAA. Further it leaves the rectal mucosa behind. This may cause persistence of symptoms and future risk of malignancy. The ileorectal anastomosis has the advantage of better continence, especially at night. This operation may be considered in:
Discuss the complications of pouch surgery?
Discuss pouch surgery and pregnancy?
Pregnancy and delivery are safe in patients with IPAA. Whether vaginal or Caesarean delivery is better remains controversial. The type of delivery should be influenced by obstetric consideration but also the potential risk of sphincter injury. Some have favoured Caesarean sections
Discuss the types of pouch?
The J, S and W reservoirs are the most common types of pouches used. Selection of pouch design depends on a variety of factors, including age, patient size and individual anatomy.
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