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Surgical treatment of ulcerative colitis

Jul 20, 2021

Ulcerative colitis – this is a chronic immuno-inflammatory disease in which only the large intestine is involved in the inflammatory process, while inflammation is most often limited to the mucous membrane. The disease develops as a result of a combination of several factors, including genetic predisposition, defects in Innate and acquired immunity, intestinal microflora and various environmental factors.
If drug therapy is ineffective, the most common method of surgical treatment of the disease is coloprotectomy with the formation of a J-shaped ileo-reservoir and reservoir-anal anastomosis.

What is the operation?
The rectum in its structure has a wide part that can stretch and absorb up to 800 ml of stool, the so-called reservoir. Therefore, a person has an urge to defecate.
During the operation, the patient removes the entire colon (colon and rectum). When it is removed, the reservoir capacity must be restored, since the small intestine itself does not have such a function. Therefore, a reservoir resembling the English letter J is formed from the small intestine (iliac), which will perform the function of an ampoule of the removed rectum. 

What you need to know about the surgical treatment of this disease.
Typically the operation is performed in 2 stages:     

  1. The first step is to remove the entire colon, form a J-shaped reservoir, and connect the reservoir to the anal canal. Such an operation usually ends with the formation of a loop ileostomy. A stoma (a surgically created hole connecting the cavity of an internal organ with the external environment) is necessary to ensure that the reservoir and the connection of organs heal and there are no severe postoperative complications. 
  2. Reconstructive surgery (closure of the stoma) as a rule, it is carried out after 8-12 weeks. This is the optimal time for healing the small intestinal reservoir. All this time, the patient must wear a colostomy bag and take care of the stoma. 

Some surgeons prefer to perform this operation in one step. However, in this case, there is an increased risk of failure of the reservoir or tank-anal connection.

Patients with severe disease, taking high doses of corticosteroids, as well as in emergency cases, the operation can be performed in 3 stages. The first stage involves the removal of the colon and the formation of the terminal ileostomy. After surgery, the patient undergoes treatment and rehabilitation. When laboratory parameters are restored to normal values, the rectum is removed (proctectomy), the formation of a J-shaped small intestinal reservoir, reservoir-anal anastomosis and loop ileostomy is performed. The third operation-closing the stoma-is performed after 8-12 weeks.

 

 

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