Surgical interventions in inflammatory bowel disease: Indications, techniques, outcomes, and future directions

Table 2 Key surgical options in ulcerative colitis

Procedure	Main indication	Advantages	Limitations/risks
Subtotal colectomy with end ileostomy	Emergency toxic megacolon, perforation, severe colitis	Rapid source control; avoids pelvic dissection	Permanent stoma if no later reconstruction; rectal stump issues
Total proctocolectomy + IPAA (J-pouch)	Medically refractory UC; dysplasia/cancer	No colon/rectum; continence preserved; no permanent stoma	Pouchitis, pelvic sepsis, sexual/urinary dysfunction, pouch failure
Total colectomy + ileorectal anastomosis	Mild rectal disease; fertility concerns; high-risk for IPAA	Easier operation, better pelvic nerve preservation	Ongoing rectal disease; cancer surveillance required
Permanent end ileostomy	Unfit for restorative surgery; failed pouch; patient choice	Technically straightforward; reliable symptom control	Body image concerns; stoma complications; appliance dependence

IPAA: Ileal pouch-anal anastomosis; UC: Ulcerative colitis.