Editing Ulcerative colitis (section)

===Surgery===
{{Treatment in CD vs. UC}}
Unlike in Crohn's disease, the gastrointestinal aspects of ulcerative colitis can generally be cured by [[colectomy|surgical removal of the large intestine]], though extraintestinal symptoms may persist. This procedure is necessary in the event of: [[exsanguination|exsanguinating]] [[internal bleeding|hemorrhage]], frank perforation, or documented or strongly suspected [[carcinoma]]. Surgery is also indicated for people with severe colitis or toxic megacolon. People with symptoms that are disabling and do not respond to drugs may wish to consider whether surgery would improve the quality of life.<ref name=":1" />

The removal of the entire large intestine, known as a [[proctocolectomy]], results in a permanent ileostomy – where a [[Stoma (medicine)|stoma]] is created by pulling the terminal ileum through the abdomen. Intestinal contents are emptied into a removable [[Ostomy pouching system|ostomy bag]] which is secured around the stoma using adhesive.<ref>{{cite web |title=Living with a stoma |url=https://www.ibdrelief.com/living-with-ibd/living-with-a-stoma |publisher=IBD Relief}}</ref>

Another surgical option for ulcerative colitis that is affecting most of the large bowel is called the [[ileo-anal pouch|ileal pouch-anal anastomosis (IPAA)]]. This is a two- or three-step procedure. In a three-step procedure, the first surgery is a [[Subtotal colectomy|sub-total colectomy]], in which the large bowel is removed, but the rectum remains in situ, and a temporary ileostomy is made. The second step is a [[Proctocolectomy|proctectomy]] and formation of the ileal pouch (commonly known as a "j-pouch"). This involves removing the large majority of the remaining rectal stump and creating a new "rectum" by fashioning the end of the small intestine into a pouch and attaching it to the anus. After this procedure, a new type of ileostomy is created (known as a loop ileostomy) to allow the anastomoses to heal. The final surgery is a take-down procedure where the ileostomy is reversed and there is no longer the need for an ostomy bag. When done in two steps, a proctocolectomy – removing both the colon and rectum – is performed alongside the pouch formation and loop ileostomy. The final step is the same take-down surgery as in the three-step procedure. Time taken between each step can vary, but typically a six- to twelve-month interval is recommended between the first two steps, and a minimum of two to three months is required between the formation of the pouch and the ileostomy take-down.<ref name=":1" />

While the ileal pouch procedure removes the need for an ostomy bag, it does not restore normal bowel function. In the months following the final operation, patients typically experience 8–15 bowel movements a day. Over time this number decreases, with many patients reporting 4–6 bowel movements after one year post-op. While many patients have success with this procedure, there are a number of known complications. [[Pouchitis]], inflammation of the ileal pouch resulting in symptoms similar to ulcerative colitis, is relatively common. Pouchitis can be acute, remitting, or chronic however treatment using antibiotics, steroids, or biologics can be highly effective. Other complications include fistulas, abscesses, and pouch failure. Depending on the severity of the condition, pouch revision surgery may need to be performed. In some cased the pouch may need to be de-functioned or removed and an ileostomy recreated.<ref>{{cite web |title=Colectomy Not a Final Cure for Ulcerative Colitis, Data Show |url=https://www.mdedge.com/internalmedicine/article/11622/gastroenterology/colectomy-not-final-cure-ulcerative-colitis-data |website=www.mdedge.com |access-date=15 December 2019 |language=en}}</ref><ref>{{cite journal | vauthors = Pappou EP, Kiran RP | title = The Failed J Pouch | journal = Clinics in Colon and Rectal Surgery | volume = 29 | issue = 2 | pages = 123–129 | date = June 2016 | pmid = 27247537 | pmc = 4882179 | doi = 10.1055/s-0036-1580724 }}</ref>

The risk of cancer arising from an ileal pouch anal anastomosis is low.<ref name=Clarke /> However, annual surveillance with [[pouchoscopy]] may be considered in individuals with risk factors for dysplasia, such as a history of dysplasia or colorectal cancer, a history of PSC, refractory pouchitis, and severely inflamed atrophic pouch mucosa.<ref name=Clarke>{{cite journal | vauthors = Clarke WT, Feuerstein JD | title = Colorectal cancer surveillance in inflammatory bowel disease: Practice guidelines and recent developments | journal = World Journal of Gastroenterology | volume = 25 | issue = 30 | pages = 4148–4157 | date = August 2019 | pmid = 31435169 | pmc = 6700690 | doi = 10.3748/wjg.v25.i30.4148 | s2cid = 201114672 | doi-access = free }}</ref>