RT Book, Section
A1 Ellison, E. Christopher
A1 Zollinger, Jr., Robert M.
A1 Pawlik, Timothy M.
A1 Vaccaro, Patrick S.
A1 Bitans, Marita
A1 Baker, Anthony S.
SR Print(0)
ID 1187821807
T1 Total Colectomy and Total Proctocolectomy
T2 Zollinger’s Atlas of Surgical Operations, 11e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781260440850
LK accesssurgery.mhmedical.com/content.aspx?aid=1187821807
RD 2024/04/19
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.