Surgical treatment of ulcerative colitis
General Medicine, 2025, 27(3), 48-53.
A. Topalova-Dimitrova1, R. Nikolov1, A. Ivanova1, Z. Spasova1, G. Zhelev2, Y. Asenov2, N. Penkov2, T. Sedloev2, I. Dimitrov2
1 Department of Gastroenterology, University Hospital “Sv. Ivan Rilski” ‒ Sofia
2 Department of Surgery, University Hospital “Tsaritsa Joanna ‒ ISUL” ‒ Sofia
Abstract. Inflammatory bowel diseases (IBD) follow a relapsing-remitting course, often accompanied by extraintestinal manifestations and other autoimmune diseases, which significantly impair quality of life. The follow-up of these patients requires a multidisciplinary team of specialists. In certain cases, due to the aggressive progression of ulcerative colitis (UC), surgical treatment becomes necessary. For individuals with UC, the standard surgical technique is total proctocolectomy with or without J-pouch ileoanal anastomosis (IPAA), according to European and American guidelines. Restorative proctocolectomy (RPC) with IPAA is a two- or three-stage surgical intervention indicated for patients with UC. In emergency situations, total or subtotal colectomy with ileostomy is recommended as the first choice. This is the preferred surgical technique in patients who are at higher risk of pouch failure. The general condition of the patient is a key factor and predictor for the development of postoperative complications and pouch failure. Factors such as extraintestinal manifestations of the disease (e.g., primary sclerosing cholangitis), comorbidities, impaired sphincter apparatus anatomy, anemia, hypoproteinemia, hypoalbuminemia, and electrolyte disturbances all influence outcomes. Additionally, ongoing therapies, such as corticosteroid use, impact postoperative recovery prognosis. Complications of RPC with IPAA can be divided into early and late. Early complications may include sepsis (pelvic sepsis), thromboembolic events, abscesses, anastomotic insufficiency, bleeding, intra-abdominal hematoma, or obstruction. Late complications occur in approximately 60% of patients and include cuffitis, pouchitis, incontinence, anastomotic strictures, fistulas, chronic pelvic sepsis, among others. The assessment and proper timing for surgical intervention in UC remain unclear and should always be approached individually.
Key words: surgical treatment, ulcerative colitis, restorative proctocolectomy, ileopouch anal anastomosis, indications, complications
Address for correspondence: Antoniya Topalova-Dimitrova, e-mail: