Manhattan Abdominal Surgeons
The diseases ulcerative colitis and familial adenomatous polyposis are
historically treated by removing of the colon, rectum, and anus, making
a permanent ileostomy bag necessary. Although patients do quite well following
this procedure, many desire to treat their disease while continuing defecation
in the normal way.
Restorative proctocolectomy was developed for the surgical management of
ulcerative colitis and familial adenomatous polyposis to properly treat
the diseases while maintaining normal defection. In a restorative proctocolectomy,
the colon and rectum are removed. A J-shaped pouch is then created from
the ileum, which is the end of the small intestine. The J-shaped pouch
is then connected to the anus by sutures or staples.
Following the procedure, patients often have six to eight bowel movements
per day with excellent control. Our practice has performed more than 1700
restorative proctocolectomies, more than most centers in the world, and
this record can help you. Call 646.798.4606 for more information.
Diagnosis & Treatment
The first step to diagnose an issue includes a history and physical examination.
The diseases are often diagnosed using colonoscopy with biopsy. During
the colonoscopy, a small amount of tissue from the lining of the large
intestine is removed and sent for pathologic examination. Other studies
that may be used include plain abdominal X-rays and CT scan of the abdomen
and pelvis. Radiologic studies are often used to evaluate for the complications
of ulcerative colitis, including large intestine dilation and perforation.
In many cases, the initial treatment of ulcerative colitis includes medication
administered by a gastroenterologist, including:
- 5-ASA compounds such as mesalamine
Surgery may be recommended in patients unresponsive to medical management,
who have intolerable side effects of the medication, or who have developed
precancerous or cancerous lesions of the large intestine.
Surgery may be performed in one to three different procedures, depending
on the reason for surgery and the clinical appearance of the patient.
- First, in some situations, most of the colon is removed and a temporary
ileostomy is performed
- Following recovery, the remaining colon and rectum are removed
- After removal, a permanent ileostomy is an option
However, most people are candidates for a restorative proctocolectomy (ileal
J-pouch). A restorative proctocolectomy involves creating a pouch out
of the end of the small intestine and connecting it to the anus. The result
of this procedure is removal of the diseased large intestine with maintenance
of the normal route of defecation.
For patients with familial adenomatous polyposis, surgery is recommended
to prevent progression to an invasive cancer. There is no good medical
treatment for the disease. Your surgeon will discuss the optimal timing
of surgery with you, but it is often performed in the late teenage years
to early twenties.
Preparation & Anesthesia
The night prior to the procedure, you will be instructed to take nothing
to eat or drink after midnight. In addition, you will be prescribed a
bowel preparation. The preparation should be taken as instructed.
For a restorative proctocolectomy, you will receive general anesthesia,
in which you are completely asleep and monitored at all times by an anesthesiologist.
After anesthesia is established, an incision will be made in your abdomen
and the colon and rectum will be removed. A J-shaped pouch will then be
constructed from the ileum, which is the end of the small intestine. The
J-shaped pouch will then be connected to the anus using sutures or staples.
In some cases, a temporary ileostomy (bag) will be made to maximize the
safety of the operation for you. However, our surgeons have been pioneers
in performing restorative proctocolectomy without an ileostomy. You will
have a dressing placed over the operative site.
Following a restorative proctocolectomy, you will be admitted to the hospital.
You will receive pain medication and intravenous fluid. Once bowel function
returns, as evidenced by passage of gas or stool, your diet will be advanced.
Once you tolerate a diet, and have no signs of fever or other complications
of the surgery, you will be discharged from the hospital. You will be
given a prescription for pain medication. In the 1-2 weeks following surgery,
you will see your surgeon for a follow-up appointment.
Our Manhattan colorectal surgeons will help guide you through the entire
procedure and the healing process.