Total Proctocolectomy With Ileostomy

Written by Debra Stang
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

Total Proctocolectomy with Ileostomy

A total proctocolectomy is a surgery performed under general anesthesia to remove the colon, rectum, and anus. This surgery is typically done when inflammatory diseases of the colon have not responded to medical treatment.

After a proctocolectomy, your body needs a way to eliminate waste. The surgeon provides this by performing an ileostomy. This involves pulling part of your small intestine through an opening in your lower abdomen and attaching it to your stomach. Waste is eliminated by the small intestine into a disposable bag worn over the surgical wound opening, or stoma.

Reasons for Performing a Total Proctocolectomy with Ileostomy

This surgical procedure is a last resort for people with inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease. Surgeons usually try approaches that will save the rectum and anus before resorting to a total proctocolectomy.

This procedure may also be required to treat certain birth defects or to eliminate certain types of colon or rectal cancer. Doctors may also perform this surgery on an emergency basis if the colon or rectum is injured beyond repair.

Preparing for Surgery

Unless the surgery is required on an emergency basis, doctors will schedule it several weeks in advance to give you time to prepare. During the weeks before surgery, you should eat a diet that is high in fiber. You will also need to drink six to eight glasses of water each day. This ensures that your body is hydrated and helps your intestines function as well as they can.

Twenty-four hours before the surgery, your doctor may restrict your diet to clear liquids, such as broth, Jell-O, tea, and some fruit juices. You should not eat or drink anything after midnight on the day of the procedure.

Your surgeon may also ask you to clean your bowels before surgery. This cleansing is called “bowel prep.” Your surgeon will prescribe laxatives or a series of enemas to take the night before your procedure. This will cause you to experience diarrhea and mild cramping that lasts for a few hours.

A total proctocolectomy with ileostomy is performed in a hospital. Your surgeon will have you arrive a few hours before your surgery is scheduled. After you have checked in, you will exchange your street clothes for a hospital gown. A nurse will place an IV in your arm so that the surgery team can give you fluids and medications. The nurse may also draw blood through your IV. A normal blood test result will ensure that you are healthy enough for surgery.

How the Surgery Is Performed

When it is time for your surgery, your surgical team will wheel you into the operating room on a wheeled bed called a gurney. An anesthesiologist will inject a medication into your IV that will put you into a deep sleep. This will keep you from feeling any pain during the surgery. While you are unconscious, the anesthesiologist will monitor your vital signs.

The surgery may be done in one of two ways. Most surgeons prefer to use a laparoscope, or a tiny camera that they insert through a small incision in your abdomen. The surgery is then accomplished using tiny tools. When it is over, you will have several small incisions in your abdomen as opposed to one long incision.

If the surgeon can’t do the procedure laparoscopically, he or she will make a large incision in your abdomen. Through this incision, he or she will remove your colon or large intestine, as well as your rectum and anus. If cancer is suspected, the surgeon may also take samples of tissue from nearby lymph nodes.

The ileostomy requires making a small incision on the lower right side of your abdomen. The doctor gently draws the lowest part of the small intestine, called the ileum, through the cut and sews it in place on your abdomen. This creates a stoma through which stool can be eliminated into a disposable bag.

Risks of Total Proctocolectomy with Ileostomy

As with any major surgery, you run the risk of an allergic reaction to the general anesthetic. You may also experience heavy bleeding, damage to adjoining organs, or infection. There are a few risks specific to this procedure, but these complications are rare:

• scar tissue blocking the intestines

• inability to properly absorb nutrients

• itching, irritation, and infection around the stoma

Post-Operative Care

You will be in the hospital for at least 72 hours, and possibly as long as a week. It depends on whether you had a laparoscopic procedure or an open procedure, how quickly your bowels start moving again, and how quickly your surgical wounds heal.

You can expect to be on a clear liquid diet at first. If all goes well, the surgeon will probably let you start eating soft foods after about 48 hours.

During your stay in the hospital, you will also have several visits from an educator who will teach you how to clean and maintain your stoma.

Long-Term Outlook

Healing can take six to eight weeks—or longer if you have suffered complications or if your health was poor before the surgery. Once the surgical wounds heal and you are confident in your ability to handle your ileostomy, you will probably be able to participate in all the activities you enjoyed before surgery. Your ileostomy bag is small and easily hidden by clothes; no one will be able to tell that you’re wearing it.

Although your quality of life is likely to improve after surgery, you will still need routine follow-up care for inflammatory bowel disease. If you have a diagnosis of cancer, your doctor may recommend chemotherapy or radiation.

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