Surgical Options in Ulcerative Colitis

  • Daniel L. Beral
  • John E. Hartley


The lifetime incidence of colectomy in patients with ulcerative colitis (UC) is traditionally quoted as being in the region of 30%. However, recent population-based cohort evidence from Europe suggests that the colectomy rate after 10 years of disease may be 10% lower [1, 2]. The surgical options are governed by the indication for the surgery as well as patient-related factors including general condition, level of immunosuppression, age, and comorbidities, as well as psychological factors and patient preferences.


Ulcerative Colitis Restorative Proctocolectomy Pelvic Sepsis Indeterminate Colitis Pouch Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hoie O, Wolters FL, Riis L, Bernklev T, Aamodt G, Clofent J, et al. Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years. Gastroenterol. 2007;132(2):507–15.CrossRefGoogle Scholar
  2. 2.
    Solberg IC, Lygren I, Jahnsen J, Aadland E, Hoie O, Cvancarova M, et al. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand J Gastroenterol. 2009;44(4):431–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Brady RR, Collie MH, Ho GT, Bartolo DC, Wilson RG, Dunlop MG. Outcomes of the rectal remnant following colectomy for ulcerative colitis. Colorectal Dis. 2008;10(2):144–50.PubMedGoogle Scholar
  4. 4.
    Nicholls RJ, Tekkis PP. Ulcerative colitis. In: Phillips RKS, editor. Colorectal surgery. 3rd ed. Philadelphia: Elsevier/Saunders; 2005. p. 129–62.Google Scholar
  5. 5.
    Kock NG. Intra-abdominal “reservoir” in patients with permanent ileostomy. Preliminary observations on a procedure resulting in fecal “continence” in five ileostomy patients. Arch Surg. 1969;99(2):223–31.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohen Z, McLeod RS. Proctocolectomy with Kock pouch. In: Michelassi F, Milsom JW, editors. Operative strategies in inflammatory bowel disease. New York: Springer; 1999. p. 215.CrossRefGoogle Scholar
  7. 7.
    Lindsey I, George BD, Kettlewell MG, Mortensen NJ. Impotence after mesorectal and close rectal dissection for inflammatory bowel disease. Dis Colon Rectum. 2001;44(6):831–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Lyttle JA, Parks AG. Intersphincteric excision of the rectum. Br J Surg. 1977;64(6):413–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978;2(6130):85–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Bach SP, Mortensen NJ. Ileal pouch surgery for ulcerative colitis. World J Gastroenterol. 2007;13(24):3288–300.PubMedGoogle Scholar
  11. 11.
    Ording OK, Juul S, Berndtsson I, Oresland T, Laurberg S. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology. 2002;122(1):15–9.CrossRefGoogle Scholar
  12. 12.
    Farouk R, Pemberton JH, Wolff BG, Dozois RR, Browning S, Larson D. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg. 2000;231(6):919–26.PubMedCrossRefGoogle Scholar
  13. 13.
    Mitchell PJ, Rabau MY, Haboubi NY. Indeterminate colitis. Tech Coloproctol. 2007;11(2):91–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Yu CS, Pemberton JH, Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum. 2000;43(11):1487–96.PubMedCrossRefGoogle Scholar
  15. 15.
    Delaney CP, Remzi FH, Gramlich T, Dadvand B, Fazio VW. Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis. Ann Surg. 2002;236(1):43–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Dayton MT, Larsen KR, Christiansen DD. Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate versus ulcerative colitis. Arch Surg. 2002;137(6):690–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Uraiqat AA, Byrne CM, Phillips RK. Gaining length in ileal-anal pouch reconstruction: a review. Colorectal Dis. 2007;9(7):657–61.PubMedCrossRefGoogle Scholar
  18. 18.
    Michelassi F, Takanishi D, McLeod RS, et al. Ileal reservoirs. In: Michelassi F, Milsom JW, editors. Operative strategies in inflammatory bowel disease. New York: Springer; 1999. p. 186.CrossRefGoogle Scholar
  19. 19.
    Branco BC, Sachar DB, Heimann TM, Sarpel U, Harpaz N, Greenstein AJ. Adenocarcinoma following ileal pouch-anal anastomosis for ulcerative colitis: review of 26 cases. Inflamm Bowel Dis. 2009;15(2):295–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Al-Sukhni W, McLeod RS, Macrae H, O’connor B, Huang H, Cohen Z. Oncologic outcome in patients with ulcerative colitis associated with dysplasia or cancer who underwent stapled or handsewn ileal pouch-anal anastomosis. Dis Colon Rectum. 2010;53(11):1495–500.PubMedCrossRefGoogle Scholar
  21. 21.
    Kariv R, Remzi FH, Lian L, Bennett AE, Kiran RP, Kariv Y, et al. Preoperative colorectal neoplasia increases risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology. 2010;139(3):806–12, 812.PubMedCrossRefGoogle Scholar
  22. 22.
    Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJ, Evans GD, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59(5):666–89.PubMedCrossRefGoogle Scholar
  23. 23.
    Ahmed AU, Keus F, Heikens JT, Bemelman WA, Berdah SV, Gooszen HG, et al. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev. 2009;(1):CD006267.Google Scholar
  24. 24.
    Maartense S, Dunker MS, Slors JF, Cuesta MA, Gouma DJ, van Deventer SJ, et al. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg. 2004;240(6):984–91.PubMedCrossRefGoogle Scholar
  25. 25.
    Weston-Petrides GK, Lovegrove RE, Tilney HS, Heriot AG, Nicholls RJ, Mortensen NJ, et al. Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg. 2008;143(4):406–12.PubMedCrossRefGoogle Scholar
  26. 26.
    da Luz MA, Kiran RP, Lavery I. Clinical outcomes of ileorectal anastomosis for ulcerative colitis. Br J Surg. 2010;97(1):65–9.Google Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.The John Goligher Colorectal UnitSt James University HospitalLeedsUK
  2. 2.Castle Hill HospitalThe University of Hull Academic Surgical UnitHullUK

Personalised recommendations