Ulcerative Colitis: Surgical Management
Management of patients with ulcerative colitis remains challenging despite advances in the medical and surgical fields. These patients are usually diagnosed at a young age and face the risk of a life-altering operation or lifelong risk of cancer degeneration. These complex patients should be managed by a multidisciplinary team that includes gastroenterologists, surgeons, pathologists, enterostomal therapists, nutritionists, and pediatricians for the younger group. Medical therapy is often first-line treatment. In patients who do not respond to medical interventions, proctocolectomy is curative and should be recommended in a timely fashion to avoid unnecessary morbidity associated with aggressive medical treatment. On the other hand, patients who respond to medical therapy should be followed closely for early detection of cancer progression. The aim of this chapter is to highlight the indications for surgery, principles of surgical decision-making, operative techniques, and special considerations. In the surgical management of ulcerative colitis, one size definitely does not fit all. In the following section, we will be discussing pros and cons of different approaches based on patient and disease characteristics, surgeon skills, and physician judgment. While these opinions are based on the available evidence, there is a certain component of personal preference.