Restorative proctocolectomy

Restorative Proctocolectomy

Restorative proctocolectomy is a surgical procedure performed to treat various forms of inflammatory bowel disease (IBD), most notably Ulcerative Colitis and familial Adenomatous Polyposis (FAP). This operation involves the removal of the colon (colectomy) and rectum (proctectomy), followed by the construction of an ileal pouch-anal anastomosis (IPAA), which restores gastrointestinal continuity and preserves the anal sphincter, thus maintaining voluntary bowel control.

Indications

Restorative proctocolectomy is primarily indicated for patients with ulcerative colitis who have not responded to medical therapy, or in cases where there is a high risk of colon cancer due to the severity and duration of the disease. It is also indicated for patients with familial adenomatous polyposis as a prophylactic measure to prevent the development of colon cancer.

Procedure

The procedure is typically performed in two or three stages. The first stage involves the removal of the colon and rectum while preserving the anal sphincter muscles. In the second stage, an ileal pouch is created from the last part of the small intestine (ileum) and is connected to the anus. In some cases, a temporary ileostomy may be created to divert stool away from the newly formed pouch, allowing it to heal. This ileostomy is usually reversed in a subsequent operation.

Benefits and Risks

The primary benefit of restorative proctocolectomy is the removal of diseased tissue, which alleviates the symptoms of IBD and reduces the risk of colon cancer. Additionally, by preserving the anal sphincter, patients can maintain control over bowel movements, which significantly improves quality of life.

However, the procedure carries risks such as postoperative complications, including pouchitis (inflammation of the ileal pouch), infection, and potential issues with bowel control. Long-term surveillance of the pouch is necessary to monitor for complications and assess function.

Recovery

Recovery from restorative proctocolectomy varies among patients. The initial hospital stay can range from several days to a week, with full recovery taking several weeks to months. Patients may experience changes in bowel habits, including increased frequency and urgency, which typically improve over time as the body adjusts to the new pouch.

Conclusion

Restorative proctocolectomy offers a surgical solution for patients with severe or complicated IBD, providing relief from symptoms and reducing the risk of colon cancer. While the procedure has significant benefits, it also carries risks that must be carefully considered. Patients undergoing this surgery require ongoing medical follow-up to manage any complications and to monitor the function of the ileal pouch.