Irish Doctors came together to conduct research on modern surgery approaches for ulcerative colitis (UC), hoping to determine the best methods to decrease patient risk and increase their quality of life. UC is a chronic inflammatory disorder in the colon and rectum, infecting about 15 people per 100,000 people per year. Keep in mind, this incident rate is for developing countries such as the United Kingdom or North America, and has no reflection of the incident rate in less developed countries.
The disorder results from an immune response overstressing the attack against the bacteria that live in the digestive tract, and are caused by both environmental and genetic influences, usually a combination of the two. Although there are ways to treat the infection when it is non-emergent,
up to 10% of patients presenting with an acute episode of ulcerative colitis requiring hospital admission will have an emergency operation.
This causes great stress for doctors, patients and loved ones, which is why these researchers wanted to research and present the most common and/or the most effective approaches in both non-emergent and emergent situations.
The researchers, and most of the healthcare community classify surgery for UC into three categories, elective, urgent and emergency surgery. Elective surgery is offered as a choice for the patient before the disorder becomes an emergent situation. Elective surgeries treat for disease refractory, otherwise known as a disease that is unresponsive to non-surgical treatment, or for cells that are progressing towards becoming a tumour. Urgent or emergent surgery is usually required during a hospital stay if patients are not responding to medication, are getting progressively unwell or present signs of haemorrhage.
The decision of what operation to conduct has a variety of factors that influence which surgical treatment is best fit, such as the patients’ choice, the progression of the disease and the surgeon appointed to the case.
The first factor that is considered when deciding is the patients current clinical condition, once this has narrowed down the choices the doctor must deliberate the patient’s own preferences. In doing the second task, doctors must ensure there is appropriate counselling for the patient to be presented with each option and the risks/possible outcomes for each. Once this is done, the surgeon and their team, must reflect on their own training, experience and previous practice bearing in mind the procedure that needs to be conducted.
Given this process of deciding which operation should be done, the researchers concluded that more modern techniques were used in the elective category, and for urgent or emergent situations, there is one surgery that tends to be favoured; a subtotal colectomy with end ileostomy and rectal stump.
Although there are many operational choices, the most difficult decision for doctors to make is the timing on the surgery. In some situations, such as emergent or urgent cases, an immediate surgery is clear, however for more
elective cases the timing is challenging. There is a tough balance between giving the patients sufficient time with medical therapy to assess their response, however postponing too long poses a risk to the patient, as too much delay has been directly associated with post-operative complications, including infections, and a longer hospital stay.
There are many operations and decisions to make when it comes to UC, which cause a lot of stress on families, doctors and patients given that quality of life is usually impacted considering the location of the disorder. However, doctor training and research have been able to find a successful but difficult balance between patients being aware of their options, and the sense of emergency that time has with this disease.
Murphy, B., Kavanagh, D.O. & Winter, D.C. Modern surgery for ulcerative colitis. Updates Surg (2020). https://doi.org/10.1007/s13304-020-00719-4