The surgical treatment of ulcerative colitis.

Abstract

The markedly improved results of the surgical treatment of nonspecific ulcerative colitis over the past 20 years have been owing largely to the elimination of ileostomy complications and a better understanding of the physiologic changes which occur after operation. Complete rehabilitation of patients after appropriate surgical procedures may be expected in the great majority of these cases. Indications for surgical therapy are usually clearly defined and have been discussed. Routine use of proctocolectomy in one stage for all cases of ulcerative colitis is to be deprecated, mainly, because this removes forever, the possibility of re-establishment of intestinal continuity. The problem of reconnection, i.e., ileorectal anastomosis, demands serious consideration. It is extremely doubtful whether this operation should be carried out in the presence of active disease in the rectum or any rectal complications, such as fistula, anal incontinence, polyposis and stricture. There is urgent need for individualization and careful appraisal of each patient.