Total colectomy and proctocolectomy

Total colectomy is the removal of the whole colon, with the small intestine then joined to the rectum (ileorectal anastomosis). When the rectum must also be removed, the operation is called a proctocolectomy: a pouch is made from the small intestine and joined to the anus (ileal pouch-anal anastomosis), so that stools can still be passed naturally. These operations are performed laparoscopically or through open surgery, depending on the situation and the urgency. During a proctocolectomy, a temporary stoma (protective ileostomy) is often created for a few weeks to protect the pouch while it heals; it is closed later during a short second operation. They are offered for ulcerative colitis that resists medical treatment or is complicated, familial adenomatous polyposis (an inherited disease in which hundreds of polyps form in the colon), some multiple colon cancers, or as an emergency for severe colitis. The decision is made after discussion with the gastroenterologist and, in the case of cancer, at a multidisciplinary meeting. At Clinique Pasteur Tunis, preparation includes detailed information on life after surgery (bowel habits, diet, temporary stoma), and support from the nursing team for stoma care when one is needed.