Surgical treatment for ulcerative colitis.

Operative procedures for ulcerative colitis have become standardized and its is considered unlikely that they will undergo major modifications in the future. Several studies have shown that the numbers of individuals indicated for surgery for colitis- associated cancer/dysplasia are increasing. However, for elderly patients, the procedure and timing of surgery remain controversial, while it is important to keep in mind postoperative quality of life factors when selecting the procedure in those cases. Furthermore, the determination for surgery in severe cases should be made earlier for elderly as compared to younger patients. On the other hand, surgical treatment for refractory pouchitis has yet to be established. Surveillance colonoscopy is necessary for patients with persistent chronic inflammation, as inflammation-associated cancer is likely. In addition, it is important to keep in mind postoperative aggravation of gastroduodenal lesions, though that is less frequently encountered.