Focus on Health – Summer 01

Ulcerative Colitis Sufferer’s Lives Are Transformed by Colorectal Surgery

Many patients would agree that living with ulcerative colitis can hardly be called living at all. I causes abdominal cramps, pain, bloating and drastic weight loss, and sufferers are often “bathroom cripples” – needing to get to the facilities fast as many as 30 to 40 times a day.

Through surgery, John A. Procaccino, MD, chief of the Division of Colon and Rectal Surgery of North Shore University Hospital in Manhasset, is offering ulcerative colitis sufferers the opportunity to do those ordinary things most of us take for granted, like joining the football team, sailing or having a baby – even two!

A board-certified colon and rectal surgeon, Dr. Procaccino performs four to eight major bowel resections a week – more than many general surgeons perform in a year. For the seventh edition of the definitive surgeon’s text, Cameron’s Textbook: Current Surgical Therapy, he has written the chapter on ulcerative colitis. He is widely recognized for his skill at performing the highly technical pelvic pouch, or “J” pouch, pull-through procedure that is giving ulcerative colitis patients back their lives.

Medication is the first line of attack against ulcerative colitis, Dr. Procaccino said. However, there are four indications for surgical intervention: the drugs don’t help at all or stop helping; the side effects of the drugs (which vary from patient to patient) are too severe; the disease is of such long standing that the patient is at risk of colon cancer; and, in the case of a pediatric patient, growth is being retarded. He estimates that one-fifth to one-quarter of ulcerative colitis sufferers will eventually require surgery.

The good news about ulcerative colitis is that with the surgical removal of the large intestine and rectum the patient is cured. (In contrast, Crohn’s disease, which produces similar symptoms, affects any portion of the intestinal tract from the mouth to the anus, and there is a 38 percent chance of recurrence after surgery.) However, until the 1980s, the surgery included an ileostomy, or the creation of a permanent artificial opening in the abdominal wall, and the patient was required to wear a bag for waste. “Wearing a bag is a nuisance, to be sure,” said Dr. Procaccino, “but it meant a significantly improved quality of life for many patients.”

The operation that has evolved to become the procedure Dr. Procaccino performs today was first reported in the British Journal of Surgery in 1978; it involved removing the large intestine and rectum but then bringing down the end of the small intestine and connecting it to the anus. There have been many modifications to the original procedure that have contributed to nearly normal bowel control. Looping the small intestine (in a “J”, an “S” or even a “W” configuration) and then cutting the sapling the looped portion to create an artificial rectum, or storage organ, is a major advance. So is the development of the end-to-end anastomoser, a highly sophisticated cutting/stapling device that connects the bottom of new pouch to the anus while preserving normal sphincter function.

“Over 13 years I have performed nearly 100 of these procedures, on patients from 6 years old to 63,” said Dr. Procaccino, “and there hasn’t been a single one whose life has not significantly improved.”

For further information about the pull-through procedure or to schedule an appointment with Dr. Procaccino, the number to call is (516)730-2100