Specialty Procedures:
Inflammatory Bowel Disease Surgery

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.

Surgery for Inflammatory Bowel Disease 
Inflammatory bowel disease effects many individuals. There are two main types of inflammatory bowel disease: Ulcerative colitis and Crohn's disease.

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. 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 pullthrough 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.

Surgery for Crohn's Disease 
Surgery for Crohn's disease is also performed when medical therapies fail. Sometimes patients with Crohn's disease will get a narrowing of their intestines called a "stricture". When this occurs, and it is unable to be treated with medications, surgery is then used to either remove or, in some cases, widen the bowel. Particularly with Crohn's disease of the small intestine, bowel preserving surgery is emphasized. Other areas of the gastrointestinal tract that are involved with Crohn's disease include the colon, rectum and anus. Anorectal problems are often initially treated surgically to drain infection. Once the infection is cleared, medical treatments are then started. In particular with Crohn's disease, we work in close conjunction with our medical colleagues since oftentimes a combination of surgical and medical procedures are needed in order to maximize a patient's therapy.