September 14, 2012
Dear Mayo Clinic:
I have had ulcerative colitis for years. I've tried many medications, but none are very effective at relieving the pain and diarrhea. I'm considering surgical treatment. What can I expect if I choose to have an ileoanal anastomosis? What are the risks of the procedure?
Ileoanal anastomosis can be an effective treatment for ulcerative colitis, especially for people in your situation who have difficulty controlling symptoms with medication. The procedure is complex, and it usually requires two surgeries. But for those with severe ulcerative colitis, it can significantly improve quality of life.
Ulcerative colitis is a form of inflammatory bowel disease that affects only the colon. It does not involve the small intestine. The severity of this disease can vary significantly from one person to another. In some people with mild to moderate forms of ulcerative colitis, medication can control symptoms, and no other treatment is needed. For others, abdominal pain, rectal bleeding, diarrhea, cramps and weight loss are persistent, even with medication.
For the second group, surgery may be a reasonable choice. Surgery for ulcerative colitis usually involves removing the entire colon and rectum. In the past, the surgery included creating an opening in the abdomen, called an ileostomy, where stool would leave the body. This ileostomy was permanent. A small pouch or bag was placed over that opening to collect stool.
Now, however, ileoanal anastomosis offers people with ulcerative colitis the option of surgery without needing to wear a bag permanently. The procedure still involves taking out the colon and rectum. But instead of making a hole through the abdomen, the surgeon constructs a pouch inside the body using the small intestine. This internal pouch is connected to the anus, so bowel movements leave the body through the normal route.
Ileoanal anastomosis is usually a two-stage procedure. During the first operation, the surgeon removes the colon and rectum, creates the internal pouch and connects it to the anus. Because the new pouch needs time to heal before it will work properly, a temporary ileostomy is also made that allows stool to leave the body through that opening during the healing process.
During the second operation, the surgeon closes the temporary ileostomy, so stool can move through the small intestine and the new internal pouch, and then out through the anus. The time between the first and second surgeries is usually about three months.
Before and after the first operation, your health care team teaches you how to manage the temporary ileostomy. You may need to make some changes to your diet or eating habits while you have the ileostomy to avoid problems such as undigested food blocking the opening. For most people, though, a temporary ileostomy does not pose significant challenges.
The risks of ileoanal anastomosis are similar to the risks involved with any surgical procedure, including infection, bleeding and blood clots. After surgery, possible complications include inflammation developing within the new pouch, and a buildup of scar tissue where the pouch is connected to the anus. However, these problems usually are effectively managed without additional surgery.
By removing the colon, ileoanal anastomosis eliminates ulcerative colitis. Bowel movements after surgery can be more frequent, and they may be watery or soft because the colon is not present to absorb water. But, for most people, symptoms such as pain, cramps, diarrhea and urgent bowel movements disappear after ileoanal anastomosis and, as a result, their overall quality of life is much better than it was before surgery.
— John Pemberton, M.D., Colon and Rectal Surgery, Mayo Clinic, Rochester, Minn.