TY - CHAP M1 - Book, Section TI - Total Colectomy and Total Proctocolectomy A1 - Ellison, E. Christopher A1 - Zollinger, Jr., Robert M. A1 - Pawlik, Timothy M. A1 - Vaccaro, Patrick S. A1 - Bitans, Marita A1 - Baker, Anthony S. PY - 2022 T2 - Zollinger’s Atlas of Surgical Operations, 11e AB - The most common elective indications for total colectomy are ulcerative colitis and familial polyposis. However, sphincter-conserving procedures such as the ileoanal anastomosis (see Chapter 68) should be considered in good-risk patients. In very poor-risk patients with ulcerative colitis, particularly with a complication such as a free perforation, it is judicious to perform the proctocolectomy in two stages. Removal of the rectum is delayed until the patient’s condition is less critical. The possibility of malignancy in patients with ulcerative colitis of many years’ duration must be considered. Conservation of the anus and lower rectum by ileoproctostomy can be considered in selected patients with familial polyposis with limited rectal involvement, where the polyps in the retained rectum that do not disappear spontaneously can be destroyed by repeated fulguration. Total colectomy is also performed for severe colitis of other etiologies, especially pseudomembranous colitis. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1187821807 ER -