Ulcerative colitis, a chronic inflammatory disease of the rectal and colonic mucosa, affects approximately 250,000 to 500,000 people in the United States, with 30% to 40% of patients requiring some form of surgical intervention during the course of their disease. The predominant reason for
total proctocolectomy is for symptoms refractory to currently available medical
therapy. Less common reasons are dysplasia or
cancer. The goal of
colectomy is to prevent recurrence of systemic inflammatory disease. Consequently, surgery with
total proctocolectomy and creation of an ileal
J-pouch-anal anastomosis has become the procedure of choice for many patients without other therapeutic options. Health-related quality of life (QOL) in patients with severe
ulcerative colitis is so poor that, after ileal
J-pouch-anal anastomosis, QOL is considered to improve in most clinical studies (8 studies, improved QOL; 1 study, no change; 1 study, QOL worse than general population). However, QOL and bowel function after such surgery cannot be considered "normal" in all patients, because a substantial number still have problems with urgency, leakage, nocturnal soiling, sexual dysfunction, and
pouchitis, and some require conversion to a permanent
ileostomy after ileal
J-pouch-anal anastomosis failure. Thus, despite the availability of ileal
J-pouch-anal anastomosis, surgery does not always restore all aspects of QOL to normal.