eMedicine Specialties > Pediatrics: Surgery > General Surgery

Ulcerative Colitis: Surgical Perspective: Follow-up

Author: E Stanton Adkins III, MD, Clinical Associate Professor, Departments of Pediatrics and Surgery, University of South Carolina School of Medicine
Coauthor(s): Kenneth Azarow, MD, Program Director, Pediatric Surgery, Children's Hospital and University of Nebraska Medical Center; Professor, Department of Surgery, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Dec 4, 2008

Outcome and Prognosis

Outcomes of pouch procedures are classified as good to excellent in as many as 90% of patients. Stool frequency is less than 5 per day in as many as 74%. Difficulty with evacuation occurs in 20%. About 77% of patients require no dietary restrictions; the remaining patients have a lower stool frequency with a low-fat diet.67 Complete incontinence is reported in only 2%. Bulk-forming agents are required in as many as 30%.

Sexual dysfunction, manifest by retrograde ejaculation or impotence, occurs in 3% of males. Although Meagher et al (1998) reported sexual dysfunction to occur in only 6% of females,64 Ogilvie et al (2008) reported that 47% of females have low Female Sexual Function Index (FSFI) scores, indicating sexual dysfunction.68  Additionally, Cornish et al (2008) described a 25% incidence of sexual dysfunction manifested by dyspareunia or psychological aversion to intercourse for fear of stool leakage.69  The report also documented an increase of infertility from 8% preoperatively to 26% postoperatively. 

For excellent patient education resources, visit eMedicine's Crohn Disease Center and Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education articles, Inflammatory Bowel Disease, Crohn Disease, and Crohn Disease FAQs.

Future and Controversies

Every patient who undergoes an ileal pouch–anal anastomotic procedure, as currently performed, must be able to accept the possibilities of stool seepage or incontinence and frequent bowel movements, with a minimum of 4-6 per day. Although the procedure results in removal of the diseased organ and although it is more technically advanced than end ileostomy, it is not a perfect solution. Surgical techniques can be improved to ensure better postoperative functional outcomes.

Additional research may show that genetic predispositions, errors in oxidative metabolism, infectious causes, or autoimmune abnormalities are the primary causes of ulcerative colitis. If so, directed therapies could be pursued.

Present research is focused on the potential benefits of the use of additional immunosuppressive agents such as Methotrexate or cyclosporine alone or in combination with mannose-6-phosphate (6-MP), prednisone, or azathioprine. Finally, the use of directed antibody therapy is in its infancy. Indications and contraindications to these therapies continue to evolve.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Ronald Place, MD, to the development and writing of this article.



More on Ulcerative Colitis: Surgical Perspective

Overview: Ulcerative Colitis: Surgical Perspective
Workup: Ulcerative Colitis: Surgical Perspective
Treatment: Ulcerative Colitis: Surgical Perspective
Follow-up: Ulcerative Colitis: Surgical Perspective
Multimedia: Ulcerative Colitis: Surgical Perspective
References
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Further Reading

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Keywords

ulcerative colitis, UC, inflammatory bowel disease, colonic adenocarcinoma, Crohn disease, CD, pancolitis, proctocolectomy, biliary disease, Klebsiella species, nonsteroidal anti-inflammatory drug, NSAID, appendectomy, appendicitis, small intestinal inflammation, colonic dysmotility, colonic gangrene, toxic megacolon, abdominal pain, bloody diarrhea, tenesmus, Primary sclerosing cholangitis, PSC, uveitis, pyoderma gangrenosum, pleuritis, erythema nodosum, ankylosing spondylitis, spondyloarthropathies, multiple sclerosis, colon cancer

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Contributor Information and Disclosures

Author

E Stanton Adkins III, MD, Clinical Associate Professor, Departments of Pediatrics and Surgery, University of South Carolina School of Medicine
E Stanton Adkins III, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, and American Pediatric Surgical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth Azarow, MD, Program Director, Pediatric Surgery, Children's Hospital and University of Nebraska Medical Center; Professor, Department of Surgery, Uniformed Services University of the Health Sciences
Kenneth Azarow, MD is a member of the following medical societies: American Pediatric Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Mary L Hilfiker, MD, PhD, Chief, Division of Pediatric Surgery, Assistant Professor, Department of Surgery, University of California at San Diego Medical Center
Mary L Hilfiker, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Harsh Grewal, MD, FACS, FAAP, Professor of Surgery and Pediatrics, Temple University School of Medicine; Chief, Section of Pediatric Surgery, Temple University Children's Medical Center
Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Surgical Education, Children's Oncology Group, Eastern Association for the Surgery of Trauma, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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