4. I have severe ulcerative colitis and I am likely heading towards surgery. I would like to avoid a colostomy bag, and my potential surgeon recommended a restorative proctocolectomy (ileoanal pouch anal anastomosis). What are the possible complications of this surgery?

While most patients do very well following the surgery, and after a period of recovery are able to return to work and normal activity, as with any surgery, there is the potential for complications. The two most common complications of restorative proctocolectomy are pouchitis and small bowel obstruction. Pouchitis is an inflammation of the pouch, occurs in about 30 percent of patients. Symptoms are diarrhea, crampy abdominal pain, increased frequency of stool, fever, dehydration, and joint pain. The condition is treated with an antibiotic, either metronidazole (Flagyl) or ciprofloxacin (Cipro). Less common is bowel obstruction, which may develop due to adhesions or scar tissue from the surgery. Bowel obstruction causes crampy abdominal pain with nausea and vomiting. In about two-thirds of people who have this complication, it can be managed with bowel rest (not eating for a few days) and intravenous fluids. The other one-third of people will require surgery to remove the blockage. About eight to ten percent of patients will have pouch failure, which requires removal of the pouch and conversion to a permanent ileostomy.

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