Total proctocolectomy with ileostomy

  • 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. This will make you 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, 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, and 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.
  • 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:

  • 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 for any surgery are:

      Risks for this surgery are:

      • Bleeding inside your belly
      • 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 your intestines
      • 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 drugs you are taking, even drugs, supplements, or herbs you bought without a prescription. Ask which drugs 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 drugs 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.
      • Eat high fiber foods and drink 6 to 8 glasses of water every day.

      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 drugs 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 total proctocolectomy with ileostomy 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.

      If you have a chronic condition, such as Crohn disease or ulcerative colitis, you may need ongoing medical treatment.

  • 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

      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.