Chronic ulcerative colitis. Traditional surgical techniques.

The patient with ulcerative colitis requiring surgery has several options from which to choose. Although the pelvic pouch procedure may be preferred by many patients, in fact, all of the operations have both their advantages and disadvantages. Thus, patients should be fully informed of the various options and participate in the surgical decision making. Surgeons performing elective operations on patients with ulcerative colitis should be experienced with all of the procedures. Only then can they be unbiased in presenting the various options to the patient. Advocates of total proctocolectomy often cite the high complication rates of the Kock and pelvic pouch procedures and condemn these operations on this basis. However, the magnitude of a total proctocolectomy cannot be minimized, and the complication rate of this procedure is significant. On the other hand, total proctocolectomy is often condemned because of the permanent ileostomy and the perceived poor quality of life. This appears to be untrue. Most patients, regardless of which operation is performed, have a high quality of life. This is likely a result of the fact that physical well-being is excellent in most patients, and this may be the primary determinant of quality of life in these patients. It must be accepted, however, that some patients do have difficulties psychologically or physically with an ileostomy. Fortunately, there are several alternatives available for these people.