People who are facing surgery for ulcerative colitis today have three different options. These surgery options include a Proctocolectomy with Ileostomy, a Restorative Proctocolectomy and a Koch Pouch.
Ulcerative Colitis sufferers should consult their doctor, and do their research to decide which option is the best for them.
A Proctocolectomy with Ileostomy is the oldest and the most known of all options. This surgery is also used in emergency situations. It is also used as a back up procedure when there are complications with the other two procedures. It only requires one surgery and the recovery time is basically quicker for the patient. In this procedure, the entire colon, rectum and the anus are removed, and the end of the small intestine is brought out through a hole in the abdomen. This hole (called a Stoma) is usually on the right side just below the belt line.
Through this hole, the waste is drained out of the body and into a specially made, lightweight bag that is discreet under clothing (unless the bag gets too full). The bag is attached to the body with a special adhesive and paste. These bags are emptied several times a day and changed by the patient every 3-5 days. Possible complications one might face with having an ileostomy would include a prolapse of the stoma, peristomal hernia, parastomal fistulization, skin irritation, ileostomy retraction and high stomal output (ileostomy flux). Another very minor complication would be an occasional leak in the appliance (the bag). This is remedied by cleaning up the mess the leak made and changing the bag.
The second surgery option is what is called a Restorative Proctocolectomy aka. Ileoanal Pouch Anal Anastomosis (IPAA). This is a newer procedure that allows the patient to eliminate waste through the anus. Without the use of a bag, this is a preferred option to many people. The process of an IPAA procedure is carried out in two surgeries. The first surgery consists of the removal of the colon and the rectum while the anus and anal sphincter muscles are preserved. The end of the small intestine (called the ileum) is made into a pouch and pulled down and connected to the anus. A temporary ileostomy is also performed to allow the new pouch time to heal. After the pouch has time to heal, usually about ten to twelve weeks after the initial surgery, another surgery is done to close the temporary ileostomy. After this operation, the internal pouch serves as a reservoir for waste. Possible complications one might face with having an ileoanal pouch anal anastomosis would be an inflammation of the pouch (known as Pouchitis), bowel obstruction, which may develop due to adhesions or scar tissue from the surgery, and pouch malfunction, which would require the removal of the pouch and a permanent ileostomy made.
The third option is possibly the least known one called a Koch Pouch aka. continent ileostomy. Like the IPAA procedure, a pouch is constructed out the small intestine to store the waste. However in the Koch Pouch, when the person needs to get rid of the waste ,a thin tube is inserted into the stoma to drain the contents a few times a day. A one-way nipple valve sitting flush with the skin, stops the stool from coming out at any other time. The patient will wear a stoma cap, gauze or a Band Aid to protect the stoma. A complication of a Koch Pouch would be nipple valve slippage, which makes it difficult to irrigate or stop the stool coming out at odd times. Treatment of nipple slippage requires revision surgery with re-fixation of the nipple valve. Pouch removal and a permanent ileostomy is also considered for this complication.
As mentioned earlier, surgery for ulcerative colitis is a life saving and health restoring procedure. Many people go on to lead very happy, healthy and active lives even after the diseased colon has been removed.