Surgeons want to be involved early in the care of hospitalized patients with ulcerative colitis, even if it’s uncertain that the patient will need or agree to the procedure, said Jean Ashburn, MD, at the Crohn’s & Colitis Congress on January 21.

“There’s a lot to talk about, and we want to visit your patients with you as early as we can, so we can establish trust with the patient,” she said. "We love to be involved right from the beginning."

Dr Ashburn is an assistant professor of surgery and colorectal surgeon at Atrium Health Wake Forest Baptist Hospital in Winston-Salem, North Carolina.

This early introduction allows patients and surgeons to discuss expectations, she said. “If we’re talking to a patient who may have an ostomy, they will have a lot of questions. Will I be able sleep through the night? What about my diet?” It’s important to talk about possible complications and to address concerns about fertility, sexual function, and how surgery and recovery may affect their daily lives, Dr Ashburn stated.

One of the main concerns in approaching surgery is the patient’s nutritional status, she said. Patients acute severe ulcerative colitis who have required are often malnourished, sometimes severely. “Some patients are too sick to go into surgery immediately. Others may be too sick to wait,” Dr Ashburn explained. “But if we can, we really want to get those patients in better condition from a nutritional perspective because it makes a significant difference in their recovery.”

“We should lay out all the options available to the patient who’s considering surgery, whether a J-pouch or permanent ostomy, depending on the condition,” Dr Ashburn continued. “And it’s absolutely essential to involve an enterostomal therapist,” she said. This is the time to review the process of the 2- or 3-stage ileal pouch-anal anastomosis procedure, and to discuss in detail the timing and staging of each procedure.

Planning should also include postoperative care to prevent thrombosis for at least 2 weeks after surgery. Dr Ashburn also explained the importance of discussing and planning for postoperative immunonutrition to help the patient recover and rebuild strength.

Dr Ashburn emphasized, “It’s important to see the surgeon as part of a multidisciplinary team. The most important thing of course is to remove the diseased area. But surgeons aren’t just technicians.”

--Rebecca Mashaw

Reference:

Ashburn J. Surgery in UC. Presented at: Crohn’s & Colitis Congress. January 21, 2022. Virtual.