Colectomy with ileorectal anastomosis (IRA) for inflammatory bowel disease (IBD)

This is an operation to remove the whole colon and join the ileum (the last part of the small intestines) directly to the rectum.

What forms of IBD is colectomy with IRA surgery used to treat?

It is suitable for a small number of people with ulcerative colitis. Rarely it is also used to treat Crohn’s disease affecting the colon - Crohn’s (granulomatous) colitis and ileocolitis.

Why is colectomy with IRA surgery needed for IBD?

If your inflammatory bowel disease (IBD) is not responding to other treatments and you have severe inflammation or damage to all, or part, of your large intestine (colon) then you may have a colectomy.

You may also have this surgery if your bowel perforates or you have bowel cancer or a very high chance of developing it.

How is colectomy with IRA surgery done?

The day before your surgery you will likely be asked to take a bowel preparation which will give you diarrhoea to clear the bowel of any faeces to make the operation easier. You may also need to follow a specific diet and avoid some medications.

Shortly before your surgery your blood pressure and breathing will be monitored and you will be prepared for theatre. You may be given medicine through a vein in your arm. Just before the surgery you will be given a general anaesthetic which will put you in a sleep-like state so that you won’t be aware of what’s happening.

Colectomy surgery can be carried out either through open surgery or laparoscopic (keyhole) surgery. The type of surgery you receive will depend on your circumstances and the surgeon you have. It should be discussed with you prior to your operation.

Open surgery: An incision will be made along your abdomen to provide access to the colon for your surgeon. They will then identify the damaged section of the colon and remove it.

Laparoscopic surgery: Several small incisions (or ports) are made in the abdomen. A small camera is inserted through one of the ports to direct the surgeon to the colon. Surgical instruments are inserted through the other incisions and the colon is pulled through one of the ports and operated on externally, before being reinserted. This type of surgery is meant to result in a quicker recovery time for the patient and also less scarring. In some cases the surgeon will discover during surgery that they need to convert to open surgery due to unforeseen circumstances.

Once the surgeon has removed the colon the intestinal tract must be reconnected so you can pass stools. In IRA surgery the ileum (the last part of the small intestine) is joined directly to the rectum. This is different to ileal pouch-anal anastomosis (J-pouch) surgery in which a pouch is formed out the end of the small intestine before being reconnected.

How the surgeon closes the incision/s in your abdomen depends on whether you received open or laparoscopic surgery. The wound in open surgery is often large and runs down the middle of the abdomen. In general this will be closed used clips which will then need to be removed around 10 days after surgery. The wounds in laparoscopic surgery are much smaller and often a special type of glue is used to fix them back together. This glue dries and falls off naturally. In both cases stitches may also be used - these can be dissolvable or may need removing around 10 days after surgery.

Recovering from colectomy with IRA surgery

After your surgery you may need to stay in hospital for around a week until you regain normal bowel function. The length of your stay will also depend on whether you had open or laparoscopic surgery.

You may receive nutrition through an intravenous drip until your bowel has healed a little and you are able to drink more normally. You will probably be encouraged to eat and drink as soon as you feel able and will be encouraged to move around.

It will probably take several weeks after leaving hospital for you to begin to feel better. You will probably be advised against any heavy lifting or strenuous physical activity and you may not be able to drive for a couple of weeks.

You may be recommended to follow a certain diet, or avoid certain foods, in the weeks immediately after surgery to aid healing.

Possible complications of colectomy with IRA surgery

Wound infections can occur at the incision sites - in both open and laparoscopic surgery. These may require antibiotics to be treated
Injury to nearby organs including the intestines and bladder or blood vessels and the ureter can be caused
Occasionally the join (anastomosis) between the ileum and rectum can leak. This is known as an anastomotic leak. In some cases further surgery is required to fix the leak, while in others draining of the fluid from the leak can allow the anastomosis an opportunity to heal properly
Hernias can occur at the surgical incisions
The colon absorbs a lot of water from the food we eat and certain vitamins and minerals. Without your colon you may be at risk of malnutrition, dehydration and vitamin and mineral deficiencies
There is an increase in chances of getting cancer in your rectum
You may get proctitis in your rectum
There is a chance that ileo-rectal anastomosis will fail which would lead to a permanent stoma being formed

Things to know about colectomy with IRA surgery

How your bowel works after the operation is unpredictable. At first you will have frequent, loose stools. This should improve and for most people averages out at around 6 bowel movements per day, however this varies greatly between people. You may also experience frequent urgency to open your bowels
This operation is generally able to be performed in one go, however your surgeon may decide to do it in two stages. If this is the case then you will have a temporary ileostomy until the second operation takes place
It has been reported that there is a failure rate of around 24% 10 years after having this surgery which has resulted in further surgery being required
You will probably be required to have regular endoscopies and biopsies in the years after your surgery to monitor for signs of cancer