Surgical Therapy for Ulcerative Colitis and Crohn's Disease

CHRONIC ULCERATIVE COLITISNearly half of patients with chronic ulcerative colitis undergo surgery within the first 10 years of their illness, mainly because of the chronic nature of the disease and the tendency for relapse.In addition, occasional fulminant complications occur with ulcerative colitis, and a significant risk of malignant degeneration exists.The indications for surgery vary widely, and these differing indications have different implications for the timing of surgery and the choice of operative procedure.Indications for surgical intervention include (1) massive unrelenting hemorrhage, (2) toxic megacolon with impending or frank perforation, (3) fulminating acute ulcerative colitis that is unresponsive to steroid therapy, (4) obstruction from stricture, (5) suspicion or demonstration of colonic cancer, (6) systemic complications, and (7) intractability.In children, an additional indication for surgery is failure to mature at an acceptable rate.For most patients with ulcerative colitis, a colectomy is performed when the disease enters an intractable, chronic phase and becomes a physical and social burden to the patient.With sphincter-sparing operations available for patients with ulcerative colitis, it has become critically important to avoid standard proctectomy wherever possible and to distinguish diagnostically patients with ulcerative colitis from those with Crohn's disease. Indications for Surgery Intractable DiseaseA failure of medical management, reflected by chronic physical disability and physiologic dysfunction, is by far the most common indication for surgery