When surgery is necessary in ulcerative colitis, total proctocolectomy (removal of the colon and rectum) is the operation of choice and provides a permanent cure. Partial colectomy is rarely performed because of the high probability that the disease will recur in the remaining colon.
Ileoanal pouch anastomosis has replaced the classic permanent ileostomy as the procedure of choice to accompany a proctocolectomy. This newer procedure eliminates the need to wear an external ostomy appliance.
About 20 percent of ulcerative colitis patients will require surgery at some time during their illness.
Surgery is not a cure for Crohn's disease, but is reserved for certain complications and for times when symptoms do not respond to medical treatment.
An estimated two-thirds to three-quarters of persons with Crohn's disease will have one or more operations in the course of their lifetimes.
The typical (classic) operation for Crohn's disease not involving the rectum is resection (removal of a diseased segment of bowel) and anastomosis (reconnection) without an ostomy. Sections of the small or large intestine may be removed. No operation can cure Crohn's disease, as symptoms are likely to recur.
Using "return of symptoms" as a definition of recurrence after surgery, about 20 percent of patients show a recurrence after two years, 30 percent after three years, and up to 80 percent by 20 years. Not all recurrences require re-operation.
Most surgeons now feel that using wide margins (removing healthy bowel adjacent to a diseased bowel segment) does not reduce the rate of recurrence in Crohn's disease, so only the involved segment is removed.
Many studies show that recurrence rates are significantly lower when ileostomy is performed than when resection and re-anastomosis are performed.
Recurrence rates seem to be lower when the initial operation is to relieve a blockage. In contrast, recurrence rates seem to be higher in more "aggressive" disease, e.g., illness that involves ulcerations, abscesses, or fistulas (an abnormal channel that forms between two loops of intestine, or runs from the intestine to another organ).
Postoperative disease recurrence is almost always located at or in front of the site of anastomosis. In ileostomy, recurrences are often (but not always) located at the end of the small bowel adjacent to the ileostomy.
Recent studies suggest that the rate of postoperative recurrence can be delayed or decreased by taking mesalamine, immunosuppressive agents, or antibiotics.
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