Severe Ulcerative Colitis

The indications for surgery in ulcerative colitis are intractability and colorectal cancer risk. Ninety percent of patients in our series undergo surgery for intractability, while 10% are operated for dysplasia. The vast majority of patients with ulcerative colitis undergoing surgery opt to have an ileoanal pull-through procedure. Elderly patients and those with sphincter problems usually are not good candidates for this operation and most undergo proctocolectomy and Brooke ileostomy. We may perform a mucosectomy and hand-sewn ileoanal anastomosis since this operation removes all diseased mucosa or in patients with short mesentery, a stapled ileoanal anastomosis is performed instead.