Ulcerative Colitis

Ulcerative colitis effects only the rectum and colon. It is a disease of the lining of the large intestine and does not effect deeper layers of the bowel or the small intestine.   Symptoms of ulcerative colitis may include: abdominal pain, bloody diarrhea, fatigue, weight loss, loss of appetite, rectal bleeding, loss of body fluids and nutrients, anemia caused by severe bleeding.

Most of the time, ulcerative colitis can be successfully treated with medical therapies. When these medical therapies fail, however, surgery can be offered. The surgery for ulcerative colitis involves removing the entire colon and the entire rectum. In most cases, however, the anus can be preserved and a reconstruction operation called an ileoanal pull-through can be performed. This surgery is usually done in two stages. At the first operation, the diseased colon and rectum are removed and then a portion of the small intestine is used to make a "neorectum" and this is then connected to the anus. A temporary ileostomy bag is then created. After approximately 8-12 weeks, this temporary bag can be taken away and then the patient can then evacuate in a normal fashion.

Ileoanal J-pouch for Ulcerative Colitis

This specialty procedure is offered to patients who have ulcerative colitis or familial polyposis. Patients with ulcerative colitis who are failing medical therapy can have this procedure done in two or three stages. In the first stage, the colon or the colon and rectum is completely removed. A new rectum called a "J-pouch" is then created and then "anastomosed", or hooked up, to the muscles of continence (anal sphincters). Usually a temporary, diverting ileostomy, or bag, is created upstream from this complicated surgery so that it can heal without infection. Between 6-12 weeks of this initial procedure, the temporary ileostomy, or bag, is taken away with a smaller operation.

Familial Adenomatous Polyposis

Patients with a polyp disorder called "familial adenomatous polyposis" (FAP) are good candidates for this procedure. Again, the colon and rectum are completely removed and, oftentimes, the last _ inch to _ of an inch of the anus is "stripped" of all polyps. The J-pouch, or S-pouch, is then created with a temporary diverting ileostomy. This temporary ileostomy is then taken away 6-12 weeks after the first procedure. There are other alternatives to patients with familial adenomatous polyposis such as a total colectomy with ileorectal anastomosis. The type of operation is individualized to the aggressiveness of the polyposis disease.

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