Surgical Treatment of Mucosal Ulcerative Colitis

David M Schwartzberg, MD, FACS

The incidence of inflammatory bowel disease (IBD) has continued to increase in recent decades. Despite medical breakthroughs, patients continue to require surgery as part of their treatment algorithm. While the spectrum of IBD, Crohn's disease (CD), and ulcerative colitis (UC), may have overlapping medical and surgical treatments, UC also shares a surgical treatment with patients who suffer from familial adenomatous polyposis, as both require extirpation of the colorectum, and thus, has led to a subspecialized field of pouch surgery.

Minimally invasive options have been established, yet the fundamentals of UC surgery have remained unchanged, namely, to remove the diseased bowel and restore continuity with an intestinal pouch. It has only been since the end of the 20th century that significant advancements in the treatment of UC have occurred, and although treatments yielded tremendous hope for life without disease, early operations resulted in a permanent ostomy. Surgical advancements then progressed to give patients the opportunity to be void of a stoma; however, the complexity of the operations and their associated complications have not only created specialists in pouch surgery, but also specialists in reoperative pouch surgery.

It is a humbling effort to care for patients with IBD, as compassion, knowledge, and surgical skill are all equality important to offer ideal treatments to patients living with these conditions. Many of these patients are on intricate medications, malnourished, and have complex surgical anatomic considerations with diseased bowel and prior abdominopelvic operations. Medical advancements have given patients the opportunity to avoid surgery; however, it has sadly delayed surgery in many patients and has given rise to more staged operations for patients with UC.

In this issue of Clinics in Colon and Rectal Surgery, entitled “Surgical Treatment of Mucosal Ulcerative Colitis,” several aspects of the treatment of UC are addressed. The collection includes the diagnosis and monitoring of UC, concepts of medical management and dysplasia, emergent and elective surgery, the utilization of minimally invasive surgery for UC, staged operations, the use of ileoproctostomy compared with an ileal pouch-anal anastomosis, and the historical significance and evolution of pelvic- and K-pouches. Additionally, we will discuss redo pelvic pouch surgery and its indications in the setting of CD or suspected CD related to pouch dysfunction. Our efforts are to better provide the readers with knowledge and authority to optimally care for patients suffering from UC.

Publication History

Article published online:
28 December 2022