Jay Yepuri, MD, MS, is a board-certified gastroenterologist and a practicing partner of the Texas Digestive Health Association (DHAT).

Ulcerative colitis is a chronic disease that causes inflammation of the digestive system and sometimes inflammation of other parts of the body. It is a form of inflammatory bowel disease (IBD), which also includes Crohn's disease and indeterminate colitis.

Most cases of ulcerative colitis are not serious. However, when the disease significantly reduces your quality of life, cannot be treated with medication, or is life-threatening, surgery may be required.

The two most common procedures to treat ulcerative colitis are ileostomy and ileal pouch-anal anastomosis (IPAA), commonly referred to as j-pocket.

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Ulcerative colitis surgery means removing the large intestine or colon (called colectomy). After the large intestine is gone, the stool needs another way to leave the body. The two most common ways to achieve this goal are to place an ileostomy or create a j-pocket. 

In an ileostomy, part of the small intestine passes through the abdomen. This is called a stoma. The stool leaves the small intestine through the stoma and is collected in a device (usually called a pouch or bag). Ileostomy appliances are poured into the toilet several times a day.

In IPAA or j-pouch, the end of the small intestine is connected to the rectum. This is usually achieved through a series of two to three operations, although some surgeons will do it in one operation. When completed in multiple operations, the first operation is always a colectomy and placement of a temporary ileostomy.

Sometimes a j-pouch is created at the same time, but in some people, it is performed during the second operation. The subsequent operation is to reverse the ileostomy and connect the j bag. After the j-pouch operation, the patient can pass stool through the anus.

These operations can be done through open incisions, or, now more commonly, laparoscopic surgery (performed through small incisions with the help of cameras and gadgets). Ideally, surgery is scheduled, but sometimes it is emergency surgery.

For patients who are sick and/or malnourished due to ulcerative colitis, the operation may be delayed for a short period of time, allowing the patient's condition to stabilize before the operation. For those who are sick, j-pouch surgery can be done in three steps instead of two, allowing the body time to heal.

These operations are usually reserved for adults, but children may need them. It is used when a serious illness requires surgery, but unless it is clearly needed, this type of surgery is not the first choice for children.

A study of ileostomy surgery for ulcerative colitis showed that complications that require more surgery are rare. The complications of open surgery or laparoscopic surgery are often the same. 

Some complications include:

In a center study of 58 patients undergoing j-pouch surgery, approximately 40% of the patients experienced complications after the surgery. Some of the potential complications include:

Surgery is used to treat ulcerative colitis for several different reasons.

The first reason for colectomy for ulcerative colitis is that this condition can no longer be treated with medication. There are many different medicines available to treat this disease. However, existing drugs may not significantly reduce inflammation.

Some drugs used to treat ulcerative colitis may take time to control the disease. It can also happen that the disease becomes severe enough that there is not enough time for the drug to take effect.

Although uncommon, ulcerative colitis is also associated with colon cancer. After about 8 to 10 years of colon cancer, the risk of colon cancer increases. If the colon may cause changes in colon cancer, surgery to remove the colon may be the best option.

Surgery can also be performed to treat complications. Two of these include toxic megacolon (the colon becomes severely swollen) and intestinal perforation (holes). These are rare emergencies, but they will be the reason for colectomy.

Another reason for ulcerative colitis surgery is to improve the quality of life. Patients may think that the symptoms of the disease prevent them from leading a full and happy life, and surgery provides an opportunity for improvement.

Everyone's preparation for colectomy may be different. Before surgery, several steps may need to be taken. Ask your doctor how to prepare for this operation.

Most people undergoing ulcerative colitis surgery are referred from their gastroenterologist. The surgeon who completes the operation is usually a colorectal surgeon who specializes in digestive system surgery.

The enterostomy treatment nurse (ET nurse) will help with the ileostomy before and after the operation. The ET nurse will help decide where to place the stoma and advise on which type of appliance is the most effective.

Surgery for ulcerative colitis is performed in the hospital. You will be hospitalized for a few days after the operation (if you are making a j-bag, you will be hospitalized at every step).

Comfortable clothes should be worn. Because surgery means hospitalization, patients will not want to bring any special or expensive clothes. You will be wearing a hospital gown, but you may need to bring your own socks, slippers and gown or comfortable pants.

Because this is an operation of the digestive system, it is necessary to fast in advance. There may also be prescribed preparations in which special laxatives are used to clean the intestines. After surgery, there may be one or more days of fasting or drinking only clear liquids. Your diet will gradually expand.

You may need to stop taking certain medicines before the operation. You may need to start taking other medicines, such as antibiotics, before the operation. The surgeon will provide a complete list of the medications you are currently using and prescribe any medications needed before the operation.

It is important to tell your medical team about all the medicines and supplements you take. Even over-the-counter vitamins and herbs. It may be necessary to stop taking certain supplements a few days before the operation.

Due to the hospitalization involved, patients need to bring some items, such as glasses, mobile phones and chargers, earphones, and books or other activities to pass the time. You may also need your own toiletries, such as soap, shampoo, moisturizer, and anything you need for sleep, such as a sleeping mask.

Patients will not be able to drive, so someone needs to take them home after they are discharged from the hospital.

Patients will be encouraged to quit smoking before surgery. In some cases, other changes may need to be made, such as focusing on nutrition and weight management.

Since ulcerative colitis surgery requires at least one hospitalization, and possibly three hospitalizations, its cost is higher than outpatient surgery. An ileostomy surgery may cost approximately US$39,000, while a j-pouch surgery may cost US$50,000.

Please consult your insurance company for coverage and possible copayments. Using hospitals and surgical teams in your planning network is the key to preventing any unexpected charges.

A few days before the operation, you will keep in touch with the surgical team and other healthcare professionals.

Patients will collect and monitor their vital signs such as blood pressure, heart rate and body temperature before and during the procedure. The intravenous (IV, through the vein) line will be started to administer the fluids and any medications needed.

The patient will be pushed into the operating room from the preoperative area. General anesthesia will be given. Epidural anesthesia may also be used to control pain. Each operation takes several hours. The operation to create the j bag will be the longest operation.

The patient will stay in the recovery area for a period of time before being sent to the ward. 

If an ileostomy is placed, the patient will wake up with a stoma. There will be an ileostomy appliance above the stoma to collect waste. The hospital staff will help you empty the storage bag and teach you how to change the storage bag during hospitalization.

Patients usually manage pain through a pain pump connected to an intravenous injection. The paramedic will provide instructions on how to use the pump.

Connecting the j bag after the operation will encourage the patient to try to use the bathroom. As the recovery continues, the diet will advance from liquid to solid.

Surgery to treat ulcerative colitis is the main abdominal surgery. Recovery takes several weeks. It is important to discuss with your medical team about re-driving, doing housework, and other activities that might exercise your abdominal muscles.

For open surgery, you will have a large incision that needs care, including dressing changes. For laparoscopic surgery, there will be several smaller incisions. The surgeon’s office will provide instructions on how to shower through the incision. It may not be recommended to take a bath until the incision has healed slightly.

The new stoma will adjust and become smaller over time. As the area heals and the swelling decreases, you may need to try different types of appliances.

At home, the diet may be kept simple and gentle at first, and then progress over time. This is to avoid the possibility of intestinal blockage. With the new j-pouch, your stool may be acidic at first, and avoiding foods that cause loose stools may help. The surgeon's office will provide more specific dietary guidance.

There will be an adjustment period after the stoma. It is natural to have a complicated feeling about the life of an ileostomy. It can be helpful to work with mental health professionals and stoma nurses (ET nurses).

On the first day home from a new stoma, home care may be recommended. Caring for the stoma and changing appliances at home requires practice, and skilled nursing can help.

Due to weight lifting or walking restrictions, you may still need a few more weeks of help with housework. You may also have been taking painkillers for a while, and you need to be careful not to overwork or make major decisions before you feel better.

As the patient recovers, it will be important to return to normal activities. The surgeon’s office will help decide when the patient can return to work, school, housework, exercise, and sex.

The J-pouch operation is a series of two to three operations until the last operation connecting the j-pouch. An ileostomy is a type of surgery and usually does not require any other surgery.

Patients should keep in touch with their colorectal surgeon and extend a helping hand in the event of any complications. 

Having a colectomy means making some adjustments to the lifestyle, but most patients feel better after recovery and return to all previous activities. 

The biggest adjustment may be diet. The diet should be expanded over time in order to resume eating as many fresh fruits and vegetables as possible. A dietitian with experience in IBD or digestive disorders may be helpful in providing advice and food supplements.

Patients usually worry about dating and intimacy after surgery. Many people feel better after undergoing ulcerative colitis surgery. This helps them return to the various aspects of life they used to enjoy.

People with j-pouch or ostomy can date, get married, have sex, and have children. It is important to keep in touch with your doctor to know when it is safe to resume these activities.

Sexual activity may resume within a few weeks after surgery. An ostomy will not hinder you, although some people prefer to use an ostomy belt or wear a smaller ostomy bag designed for swimming or intimate activities.

For those who want to become pregnant, it is important to establish a schedule with the colorectal surgeon and gastroenterologist. There is no answer as to when is the best time to plan a pregnancy. Everyone will be different.

People who have an ileostomy need to take care of their stoma and the skin around the stoma (the skin around the stoma). Stoma appliances should be replaced regularly. The timetable will vary from person to person. If any problems arise, a skilled ostomy nurse will help.

When traveling, please remember to bring a kit containing the items needed to replace your electrical appliances.

Patient advocacy groups and support groups can help you learn more about stoma care. Contacting the stoma supply company can also help get advice on how to best use their products. Medical supply stores can also provide good information about which supplies are available and how to use them.

If a person with ulcerative colitis has serious illness, complications, or wants to live without certain symptoms, surgery may be required. The operation starts with a colectomy to remove the colon. Then connect the stool to leave the body by placing an ileostomy or creating a j-pocket.

If a j-pouch is created, one or two further operations are required. All these operations are performed in the hospital under general anesthesia and require hospitalization. They can be performed as open surgery or laparoscopic surgery.

Recovery after surgery includes incision care and stoma care, as well as gradually returning to a normal diet.

Not all people with ulcerative colitis need surgery. However, surgery is a treatment option that provides the opportunity to live without signs and symptoms of disease and prevent complications.

Although it is difficult to know that surgery is needed, most people will continue to recover and return to normal life. Keeping in touch with the surgical team and getting help with any potential problems during the process is very important for a successful recovery.

Surgery cannot cure ulcerative colitis. Ulcerative colitis is an immune-mediated disease. Surgery is an effective method of treatment. Most operations are successful and can improve the quality of life. However, complications may occur after surgery.

It is important to work with gastroenterologists and colorectal surgeons to ensure that your surgery has the best chance of success and avoid future complications.

After 5 to 10 years, 10% to 15% of patients with moderate to severe ulcerative colitis will require surgery. It is important to remember that most patients with ulcerative colitis do not need surgery to treat their ulcerative colitis.

The cost of treating IBD has not been well studied. However, an ileostomy surgery may cost approximately US$39,000, while a j-pouch surgery may cost US$50,000. The amount of insurance coverage depends on many factors. Choosing surgeons and hospitals in your network may help reduce costs.

Cooperating with insurance companies, hospitals, and surgeons' offices is very important to understand costs and how to reduce them. It is important to understand the cost before surgery. Obtaining more than one opinion may also help reduce costs.

The decision to perform surgery is a complex decision. The type and timing of surgery selected can be very personal and based on many factors, including disease severity, cost, and personal preference.

It can be helpful to ask the gastroenterologist about the possibility of surgery in the early stages of the disease. Meeting with the surgeon and understanding the options is crucial, which can lead to better understanding and results.

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Crohn's Disease and Colitis Foundation. J bag surgery.

Schineis C, Lehmann KS, Lauscher JC, etc. Colectomy combined with ileostomy for the treatment of postoperative complications and risk factors for severe ulcerative colitis. International J Colorectal Diseases. 2020;35(3):387-394. doi:10.1007/s00384-019-03494-w.

Xu Wei, Ye Hong, Zhu Ying, etc. Long-term quality of life of early surgical complications after ileal bag anal anastomosis in patients with ulcerative colitis: a single-center retrospective study. International Journal of Surgery. 2017; 48: 174-179. doi:10.1016/j.ijsu.2017.10.070.

Holubar SD, Pendlimari R, Loftus EV Jr, etc. Drivers of cost after surgery and medication for chronic ulcerative colitis: A nested case cohort study in Olmsted County, Minnesota. Dis colorectal. 2012;55(12):1258-1265. doi:10.1097/DCR.0b013e31826e4f49.

Feuerstein JD, Isaacs KL, Schneider Y, etc. AGA clinical practice guidelines for moderate to severe ulcerative colitis. Gastroenterology. 2020;158(5):1450-1461. doi: 10.1053/j.gastro.2020.01.006. 

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