Pre-operative Preparation for a Proctocolectomy procedure
There is some important information about the pre-operative preparation for this procedure. It is imperative that you read this.
A proctocolectomy is removal of the whole colon and rectum and is essentially the same as a total colectomy (see section entitled Total Colectomy procedure), but in addition the rectum is removed also usually down to the pelvic floor leaving just the anal canal and sometimes a cuff of distal (downstream) rectum. A join up (anastomosis) is then made between the last part of the small bowel and the top of the anal canal (ileo-anal anastomosis). Because the reservoir capacity of the rectum has been removed a pouch is fashioned from the last part of the small bowel (ileal pouch) and under these circumstances an ileal pouch-anal anastomosis is made.
The usual reason for performing a Proctocolectomy and ileal pouch reconstruction is for ulcerative colitis that cannot be controlled adequately with medication or where there is a significant risk of developing cancer (ie. dysplasia has been revealed on biopsy).
Anaesthesia and antibiotics
The operation will be performed under a general anaesthetic, administered by an anaesthetist. Antibiotics will be given in the operating room.
The bowel will be operated on using keyhole surgery through several small incisions made in the abdomen. The operation involves mobilising the whole colon on its mesentery (sheet of fat containing the blood supply and lymph nodes) off adjacent structures such as the abdominal wall. The terminal ilium is transected close to the caecum and the rectum is transected just above the anal canal, approximately 4cm in from the outside. The dissection of the rectum is done through an open incision that extends from just below the belly button down to the pubic bone. This is because dissecting the rectum within the pelvis is technically very difficult and in any event an incision needs to be made through which the bowel is extracted. A J pouch is fashioned from the last part of the terminal ilium to reconstruct the reservoir function of the resected rectum. An anastomosis (join up) is then fashioned between the pouch and the top of the anal canal. To protect the join whilst it is healing and to ensure as little as possible passes through this part, the gut is de-functioned. This entails bringing out a loop ileostomy upstream. The patient has this for approximately eight weeks or until it is certain that the anastomosis has successfully healed without leaking. The ileostomy is then closed as a separate procedure.
The terminal ileum is transected as is the proximal rectum. The resected bowel is then bought out via the extended umbilical (belly button) port. An anastomosis is then fashioned between the last part of the small bowel and the first part of the rectum using a special stapling device.
Post-operative Care following a Proctocolectomy procedure
There is some very useful information regarding your care following this procedure and it is important that you take time to read it.