Ulcerative Colitis (surgical Management)

Surgical management of ulcerative colitis (UC) is curative for colonic disease, indicated for medically refractory cases, toxic megacolon, perforation, hemorrhage, or dysplasia/cancer. Procedures are divided into emergency and elective categories. Emergencies demand urgent subtotal colectomy with end ileostomy to stabilize patients, creating a Hartmann pouch for the rectal stump.

Elective surgery favors restorative proctocolectomy with IPAA, the gold standard, performed in 1-3 stages: total abdominal colectomy (TAC), completion proctectomy with pouch creation, and ileostomy reversal. IPAA forms a J-, S-, or J-pouch from the ileum, anastomosed to the anus, avoiding a permanent stoma while restoring continence. Alternatives include total proctocolectomy with Brooke end ileostomy or continent ileostomy (Kock pouch), suitable for poor IPAA candidates.

Minimally invasive laparoscopy reduces recovery time. Complications include pouchitis (50-60% lifetime risk), anastomotic leak (5-10%), infertility in females, and pouch failure (5-10%). Long-term pouch surveillance detects issues like cuff dysplasia. Multidisciplinary care optimizes outcomes, with 90-95% quality-of-life satisfaction post-IPAA.