Removal of the entire large bowel, by definition, is curative in ulcerative colitis.
Alternatives include a panproctocolectomy and terminal ileostomy, and total colectomy and ileo-rectal anastomosis.
- panproctocolectomy and terminal ileostomy:
- the whole colon is removed from the caecum to the anus
- this procedure necessitates the construction of a permanent ileostomy
- total colectomy and ileo-rectal anastomosis:
- in this procedure the colon is removed but the rectal stump is left in situ.
- the terminal ileum may be re-anastomosed to it, either at the initial operation or as a secondary procedure.
- it is possible to fashion the terminal ileum into a pouch - Park's pouch - to form a reservoir above the rectal stump. There is a risk recurrence of disease in the rectal stump. Thus the rectal mucosa is first stripped and the pouch anastomosed to the dentate line.