Has anyone ever asked if a partial colectomy can be done for left sided UC?

Remove the lining...interesting...I was wondering that, fruitgirl. It does seem you would not want the rectum so that makes sense if that's what they do. In that case I could have a J-pouch or K-pouch just for sake of wanting to stay active running, swimming, etc. Partial for me would not be an option anyway. Do they still do K-pouch; guess that's an ostomy page question.

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43, male, UC diagnosed in 1985

Flares occur after some illness: food poisoning, flu, mono...

Flares last 6 months to a year and lately involve several weeks of severe symptoms with lots of diarrhea, blood, pain, fever, dehydration.

Remissions last 1 to 4 years and are absolute with no symptoms 

Current Meds: 100 mg azathioprine, Colazal 9/day, Lialda 2/day,  60 mg 50 mg  60mg 80 mg prednisone

Xanax, Valium for anxiety

Tegretol XR for epilespy

Aside on additional pregnancy: a few months ago while waiting to see my gastro, who subspecializes in IBD treatment, I overheard 2 mothers with UC comparing notes. One told the other that she has 4 children & her UC flared after each childbirth! However, she looked very healthy & fit (ca. age 40) & seemed full of self-confidence-- so it appeared that she overcame those flares & got back to remission which was continuing. Interesting, no? / Old Hat (30 yrs with left-sided UC ... [etc.])

I personally would not reject a partial removal out of hand, though I think it would be the rare individual that would benefit. If I had only proctitis and had had it for many years then I could see that doing a colonic pouch as opposed to a small bowel J pouch might be an option. The colonic pouch would likely give better function. Personally I probably would not choose this but I definitely would consider it. There probably is not a lot of data out there as the standard surgery protocol for UC is a proctocolectomy. In Chrons they do partial removals but Chrons can involve small and large bowel and the surgical options for total removal are more restricted. However, if I had to remove the entire left side and rectum this would negate some if not most of the benefit of having almost my entire colon remain plus the fact that the disease has already involved a large part of my colon would give me pause that it might recur in what is left. As far as removing a section of the left side and leaving the rectum this might give decent function but a high risk of future UC problems.

Thanks for the info about the kpouch, summerstorm. One reason I have hesitations about an ostomy (yeah, I know that I don't really need to think about these things yet) is because I have really sensitive skin, and adhesives, even on something like a band aid, irritate my skin if I have it on for more than a day or two. So I just don't know if my skin could handle the bag or not.

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Co-Moderator, UC Forum

Status: Remission since May 2009!

Symptoms began in November 2008, ~4 weeks after giving birth to my son

Diagnosed with pancolitis on 1/30/09

Meds: Apriso (4 0.375g pills ONCE!! daily), mesalamine enema twice weekly, Natural Factors Ultimate probiotic 12/12 Formula, OrthoNovum, multivitamin.  Used prednisone (starting dose 40 mg) to get into remission.

Thread with links to UC resources and  information:

https://www.healingwell.com/community/default.aspx?f=38&m=1613482

The k-pouch is widely practiced around the country; it's the BCIR that is limited to 2-3 hospitals in the country. They are the same surgery but the BCIR uses a proprietary valve.

Sue

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dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free

Thanks for the offer, summerstorm! I'm a long way away from surgery right now, though, I think. I'm in a pretty darn good remission, and I've got quite a few drugs to run through before I'll contemplate surgery! But if it comes to it, I hope you're still around and I'll take you up on the offer! ;)

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Co-Moderator, UC Forum

Status: Remission since May 2009!

Symptoms began in November 2008, ~4 weeks after giving birth to my son

Diagnosed with pancolitis on 1/30/09

Meds: Apriso (4 0.375g pills ONCE!! daily), mesalamine enema twice weekly, Natural Factors Ultimate probiotic 12/12 Formula, OrthoNovum, multivitamin.  Used prednisone (starting dose 40 mg) to get into remission.

Thread with links to UC resources and  information:

https://www.healingwell.com/community/default.aspx?f=38&m=1613482

+1 shan2012

Bit late on this thread, but I'm in the 'no remission' - tried a lot of stuff and and unwell most of the time with BMs 10-20 times per day. None of the conventional or trial drugs now seem to have any effect. Had left side UC for 28 years. Talked with surgeon and am about to see another.

My UC has been confined to the lower 25cm with some evidence to 35cm. So in nearly 30 years it hasn't progressed further up the colon. There is no evidence I can find that says if you remove the affected part UC will reappear elsewhere. In fact the understanding of UC in general is very limited, ie. how it is caused, how to treat it (this seems to be on a case by case basis where one person will have very positive response to a drug and another no response). The evidence WRT recurrence after partial removal is not conclusive.

Yes - complete removal of the colon is a guaranteed cure, but that is not an argument for complete removal of the colon IMHO. This is about risk management and all the risk is with the patient - me. So if I am willing to have a partial removal of my colon, what's the worst thing that could happen - yep, have to remove the rest of it at a later date. For me, and I stress - for me, that's a risk I would be/am willing to take.

Further, whether a surgeon does only full or will do partial colon removal does not reflect on whether he is 'good' or not, I just cannot follow that line of thinking.

My sister has UC and is looking for surgeons that will do a partial colectomy rather than a total. Please let me know of any surgeons. Thanks.

I had a chance to talk to the surgeon (at University of Michigan) who is preparing to preform my ileoanal anastomosis (J pouch) surgery if the current meds I am on don't work.

I asked about partial colectomy because of the fact my inflammation is so left side oriented. She said that there was no real evidence either way whether my inflammation would reoccur if the inflamed portion was removed. Yet, she explained that the reason such a procedure would be impossible is because the colon's blood vessel sources are arranged in such a way that if I wanted to attach the high descending (or left most transverse) part of my colon to the rectum (cutting out the inflammation from the rectum) the lose end could not stretch anywhere near as far as would be necessary. Apparently, the blood vessels the feed the colons top stretch make a juncture in the very middle, and there is just no wiggle room for the cables to be pulled down. Theoretically, if I did not have to have the it cut out so high it would be possible. There are also blood sources that come into the low-ish side around the sigmoid region, and those would not need to be stretched as far to cross the distance of rectum.

Resectioning is possible as long as the portions of the reconnections do not have to be stretched outside of the range of the blood sources.

Background:

I have rectal and sigmoid focused UC which flairs spring and fall seasonally.

My disease had been relatively mild until very recently, and was well managed with mesalamine suppositories and enemas. After a while the disease progressed a little higher in my colon, and become resented to steroid treatment. So now I sit in the hospital, and I am going to try to remicade for the first time to see if it will reverse the course of my flair. If it does not, I am going to start the surgery progression to a J-Pouch.

fruitgirl said...
I think that in j pouch surgery the lining of the rectum is removed, which would mean UC woudln't be an issue in the rectum anymore, I believe.

I was hoping someone would come along who has full access to one of those journals. I'm sure in the full text it breaks down the chance of additional surgeries for each type of first surgery.

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