The indications for elective colectomy have not changed dramatically in recent years despite more effective medical management and advanced surgical procedures that reduce the functional disadvantages associated with conventional proctocolectomy and terminal ileostomy. Each treatment modality, medical and surgical, has advantages and disadvantages, different treatment potentials, complications and influence on the quality of life. Ulcerative colitis is a complex disease and medical and surgical treatment should be regarded as complementary, and not as a competitive treatment modality. Clinical decisionmaking should be in the hands of a well-trained and experienced team consisting of a surgeon, gastroenterologist, radiologist and pathologist. Elective operation is usually recommended to alleviate devastating consequences of chronic illness, to avoid the distressing side effects of long-term medical treatment and to prevent the development of colorectal carcinoma (Table 2).
Table 2. Indications for elective surgery in ulcerative colitis
Fulminant/unresponsive nature of first attack Inadequate response to medical therapy Side effects or complications related to medications Noncompliance with medication Extra-intestinal manifestations Recurrent haemorrhage Growth retardation in children Presence of carcinoma Cancer prophylaxis
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