The surgical management of Ulcerative Colitis has evolved dramatically from the days when patients were subjected to removal of the colon and rectum and creation of a permanent ileostomy (Proctocolectomy and Brooke Ileostomy). The creation of an ileostomy, a surgically created connection between the small intestine and the skin, necessitated the lifelong need to wear an appliance or bag to collect waste from the intestines.
For more than 25 years, innovative operations have been available that preserve continence and maintain intestinal continuity. These operations are usually performed by Board Certified Colon and Rectal Surgeons who have had specialized training that optimizes the results of surgery.
The Restorative Proctocolectomy (also called J-Pouch, Parks Pouch, Ileoanal Pull-Through and Ileal Pouch Anal Anastamosis) is now the procedure of choice for patients needing surgery for the complications of Ulcerative Colitis. The operation involves removing the colon and most of the rectum, leaving the anal sphincter muscle intact. A reservoir is then constructed from normal small intestine and sewn or stapled to the anal muscles, thereby restoring intestinal continuity.
Drs. Launer, Worsey and Salganick have performed more than 1000 Restorative Proctocolectomies and have had superior functional results. A majority of patients are able to have a single stage procedure. Patients who are very ill at the time of their operations, patients who are severely anemic or patients who take large doses of prednisone will frequently require two-stage operations. At the time of the first operation, after the colon and rectum are removed and the pouch is connected to sphincter muscles, a temporary ileostomy is constructed in order to divert waste from the pouch and allow it to heal in a stool-free environment. The ileostomy is closed in a second-stage operation performed approximately twelve weeks after the original surgery.
Some elderly patients or those who have significant sphincter muscle dysfunction are not candidates for Restorative Proctocolectomy. Patients in this category can maintain their continence post operatively with the Koch Continent Ileostomy. This operation was devised by Dr. Nils Koch of Gotteborg, Sweden in 1969 in order to provide an alternative to the conventional ileostomy and wearing a bag. An internal reservoir is constructed that contains a specialized valve that prevents the flow of waste to the outside. The reservoir is emptied 2-4 times daily by inserting a tube through a small opening in the abdominal wall.
Dr. Launer studied with Dr. Koch in Sweden in 1985. Since that time he has performed more than 500 Continent Ileostomies with remarkably good results.