What is a pan-proctocolectomy?

A pan-proctocolectomy is an operation to remove the entire colon, rectum, and anus. It is most commonly performed for patients with inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis. It may also be necessary for individuals with familial adenomatous polyposis or, occasionally, for patients with multiple bowel cancers.

In most cases, the procedure can be performed using a laparoscopic (keyhole) technique, which allows for a quicker recovery.

What does the operation involve?

This operation can be performed as an open or laparoscopic (keyhole) procedure. During surgery:

• The entire colon, rectum, and anus are removed

• Blood vessels and lymph nodes associated with the affected bowel are also taken out

• In addition to the abdominal incision, patients will have an incision around their bottom to allow for the complete removal of the anus

• The small intestine is used to create an ileostomy on the right side of the abdomen

The procedure typically takes 3-4 hours. The removed bowel is sent to the pathology department for examination, with results usually available within two weeks.

What are the risks of the surgery?

As with any abdominal operation, pan-proctocolectomy carries some risks, including:

General risks:

• Blood clots (thrombosis): Patients wear compression stockings and receive blood-thinning injections to minimise the risk

• Bleeding: While rare, a blood transfusion may be required if there is significant blood loss

• Infection: Wound infections can occur but are usually treatable with antibiotics

Specific surgical risks:

• Ileus (delayed bowel function): The bowel may temporarily stop working, causing bloating and vomiting. This is usually managed with bowel rest, intravenous fluids, and sometimes a nasogastric tube

• Bowel obstruction: Adhesions, kinks, or twists in the bowel can cause a blockage. Most cases resolve with bowel rest, but surgery may be necessary in some instances

• Pelvic nerve damage: Important pelvic nerves may be affected, potentially causing issues with bladder function and, in men, sexual function (erections and ejaculation). This risk is higher for patients who have undergone radiotherapy

• Conversion to open surgery: If a keyhole approach is not feasible, the procedure may need to be completed as an open operation

Recovery and aftercare

In hospital:

• You will have an intravenous drip for fluids, typically removed within 24 hours

• A catheter (to drain the bladder) is usually in place for 48-72 hours

• An abdominal drain may be used and is typically removed within a few days if necessary

• Pain relief is provided, often via an epidural, which may continue for at least a day after surgery

• You will be encouraged to eat and drink as soon as you feel able, usually on the same day

• Early mobilisation is encouraged to aid recovery

• The colorectal nurse specialist will visit to help you learn how to empty and change your ileostomy bag before discharge

• Hospital stay typically lasts 5-7 days for keyhole surgery and 7-10 days for open surgery, though this may vary

At home:

• You should remain mobile but avoid heavy lifting or strenuous activities for about six weeks

• Most patients can resume driving after two weeks, though recovery time may be longer after open surgery

• A follow-up consultation is scheduled approximately two weeks after discharge, though earlier appointments can be arranged if needed

• The consultant and colorectal nurse specialist will continue to provide support after discharge. A patient information leaflet on stoma care is available for further guidance

Why choose the Midlands Bowel Clinic?

• Expert colorectal surgical care with a focus on patient-centred treatment

• Specialists in minimally invasive keyhole procedures for faster recovery and reduced discomfort

• Comprehensive pre-operative and post-operative care tailored to individual patient needs

• Dedicated colorectal nurse specialists providing support for stoma care and recovery

• A multidisciplinary team offering high-quality care in a professional and comfortable environment

Contact us

If you have any questions about pan-proctocolectomy or would like to arrange a consultation, please contact the Midlands Bowel Clinic. Our friendly team is here to provide support and guidance at every step of your treatment journey.