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Definition

Total proctocolectomy with ileostomy is surgery to remove all of the colon (large intestine) and rectum.

Description

You will receive general anesthesia right before your surgery. You will be asleep and unable to feel pain.

For your proctocolectomy:

• Your surgeon will make a surgical cut in your lower belly.
• Then your surgeon will remove your large intestine and rectum.
• Your surgeon may also look at your lymph nodes and may remove some of them. This is done if your surgery is being done to remove cancer.

Next, your surgeon will create an ileostomy:

• Your surgeon will make a small surgical cut in your belly. Most often this is made in the lower right part of your belly.
• The last part of your small intestine (ileum) is pulled through this surgical cut. It is then sewn onto your belly.
• This opening in your belly formed by your ileum is called the stoma. Stool will come out of this opening and collect in a drainage bag that will be attached to you.

Some surgeons perform this operation using a camera. The surgery is done with a few small surgical cuts, and sometimes a larger cut so that the surgeon can assist by hand. The advantages of this surgery, which is called laparoscopy, are a faster recovery, less pain, and only a few small cuts.

Why the Procedure Is Performed

Total proctocolectomy with ileostomy surgery is done when other medical treatment does not help problems with your large intestine.

It is most commonly done in people who have inflammatory bowel disease. This includes ulcerative colitis or Crohn disease.

This surgery may also be done if you have:

• Colon or rectum cancer
• Familial polyposis
• Bleeding in your intestine
• Birth defects that have damaged your intestines
• Intestinal damage from an accident or injury

Risks

Total proctocolectomy with ileostomy is most often safe. Your risk will depend on your general overall health. Ask your health care provider about these possible complications.

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots
• Infection

Risks of having this surgery are:

• Damage to nearby organs in the body and to the nerves in the pelvis
• Infection, including in the lungs, urinary tract, and belly
• Scar tissue may form in your belly and cause blockage of the small intestine (this scar tissue is often called adhesions)
• Your wound may break open or heal poorly
• Poor absorption of nutrients from food
• Phantom rectum, a feeling that your rectum is still there (similar to people who have amputation of a limb)

Before the Procedure

Always tell your provider what medicines you are taking, even medicines, supplements, or herbs you bought without a prescription. Ask which medicines you should still take on the day of your surgery.

Talk with your provider about these things before you have surgery:

• Intimacy and sexuality
• Sports
• Work
• Pregnancy

During the 2 weeks before your surgery:

• You may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), Naprosyn (Aleve, Naproxen), and others.
• If you smoke, try to stop. Ask your provider for help.
• Always tell your provider if you have a cold, flu, fever, herpes breakout, or other illnesses before your surgery.

The day before your surgery:

• You may be asked to drink only clear liquids, such as broth, clear juice, and water, after a certain time.
• Follow the instructions you have been given about when to stop eating and drinking.
• You may need to use enemas or laxatives to clear out your intestines. Your provider will give you instructions for this.

On the day of your surgery:

• Take the medicines you have been told to take with a small sip of water.
• You will be told when to arrive at the hospital.

After the Procedure

You will be in the hospital for 3 to 7 days. You may have to stay longer if you had this surgery because of an emergency.

You may be given ice chips to ease your thirst on the same day as your surgery. By the next day, you will probably be allowed to drink clear liquids. You will slowly be able to add thicker fluids and then soft foods to your diet as your bowels begin to work again. You may be eating a soft diet 2 days after your surgery.

While you are in the hospital, you will learn how to care for your ileostomy.

You will have an ileostomy pouch that is fitted for you. Drainage into your pouch will be constant. You will need to wear the pouch at all times.

Outlook (Prognosis)

Most people who have this surgery are able to do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

You may need ongoing medical treatment if you have a chronic condition, such as:

• Crohn disease
• Ulcerative colitis

References

Galandiuk S, Netz U, Morpurgo E, Tosato SM, Abu-Freha N, Ellis CT. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 52.

Raza A, Araghizadeh F. Ileostomies, colostomies, pouches, and anastomoses. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 117.

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