Definition and Overview

Proctocolectomy is a surgical procedure recommended for people who require a rectum and colon resection. It partially or completely removes the colon and the rectum to treat familial adenomatous polyposis, Crohn’s disease, inflammatory bowel disease and ulcerative colitis. The procedure is irreversible and as such, is not recommended as the first line of treatment. It is only performed when medications and therapies have failed to manage the symptoms or when the disease has already significantly progressed.

Who Should Undergo and Expected Results

Patients suffering from the following conditions can be considered for a proctocolectomy:

  • Familial adenomatous polyposis - This inherited condition involves the formation of adenomatous polyps in the epithelial tissue that lines the large intestine. Most of these polyps start out as benign growths, but when left untreated, they can become malignant and spread to the colon, which can lead to colon cancer. Removing sections of the large intestine through a rectum and colon resection surgery can keep the malignant polyps from invading the colon.

  • Inflammatory bowel disease. Also known as IBD, this term actually refers to various conditions that cause inflammation in the colon (a section of the large intestine) and the small intestine. Inflammatory bowel diseases include Crohn’s disease and ulcerative colitis. This group of conditions results in key symptoms such as bleeding of the rectum, abdominal pain, diarrhea, vomiting, severe weight loss, anemia, and severe spasms or cramps in the abdominal and pelvic area. Medications and other forms of non-invasive therapy are first prescribed to the patient, with a rectum and colon resection being the last resort should the symptoms and condition fail to respond to the first line of treatment.

How Does the Procedure Work?

Proctocolectomy is performed under general anaesthesia, which means that the patient is asleep and will not feel pain during the whole procedure. The surgeon will then make an incision in the lower belly to access the bowels. The large intestine (whether in parts or completely) and the rectum will then be removed. For patients with colon or bowel cancer, the surgeon might also remove some lymph nodes to prevent cancer from spreading to other organs.

A proctocolectomy is often performed with an ileostomy, where the end of the large intestine is pulled into an incision in the lower right part of the abdomen. This end will be sewn in place to create an opening called a stoma, where the stool can come out. A drainage bag will be attached to the stoma for stool collection.

Depending on the severity of the condition, the patient might be required to stay up to two weeks in the hospital following the procedure for close monitoring.

Possible Risks and Complications

The procedure itself is generally safe, but it is irreversible, which means that careful consideration must be undertaken both by the medical team and the patient before it is performed.

The ileostomy is the leading source of post-procedure complications, including infection, because of the stoma.

Thirty percent of patients who have undergone proctocolectomy have developed an infection after the operation. Fifteen percent experienced bowel obstruction while thirty percent have had trouble with the stoma. Twenty to 25 percent of patients have required additional surgery to repair the complications and adverse side effects of the stoma.

Other side effects include the formation of blood clots in the legs (which can travel to the patient’s lungs), stroke, heart attack, breathing problems, abdominal hemorrhage, damage to the pelvic nerves and organs, infections in the abdominal cavity, and urinary tract obstruction.

References:

  • Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 113.

  • Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal Cancer. Lancet. 2010;375:1030-47. PMID: 20304247 www.ncbi.nlm.nih.gov/pubmed/20304247.

  • Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 52.

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