Is Surgery a Good Option for Ulcerative Colitis?

03 Dec, 2025

Insights by Dr. Vivek Mangla | Senior Director, GI & HPB Surgery | Max Hospitals, Vaishali and Patparganj, Delhi-NCR

Ulcerative colitis (UC) is a chronic inflammatory disease that affects the large intestine (colon and rectum). Many patients experience frequent diarrhoea, often mixed with blood, abdominal discomfort, and fatigue.

For most people, medical treatment—including steroids, immunosuppressive drugs, and biologics—helps control symptoms. But what many patients do not know is this:

Surgery for ulcerative colitis can be curative in the right patients.

In this blog, Dr. Vivek Mangla explains when surgery becomes the best option, what the procedure involves, and what long-term outcomes patients can expect.

When is Surgery Recommended in Ulcerative Colitis?

Although medicines remain the first line of treatment, surgery becomes important in the following situations:

1. Medical-Refractory Ulcerative Colitis

Some patients continue to have symptoms despite being on strong medications. When medicines fail to control inflammation, surgery becomes a safe and more effective choice.

2. Steroid-Dependent Ulcerative Colitis

Long-term steroid use can cause serious side effects such as:

• Cataracts
• Diabetes
• Bone weakness
• Metabolic problems

If a patient cannot be taken off steroids without recurrence of symptoms, surgery is strongly recommended.

3. Intolerance or Complications From Medications

Some patients cannot tolerate immunosuppressive drugs or develop complications from them. In such cases, surgery provides a long-term solution and helps patients live without these powerful medications.

4. Risk of Cancer in Long-Standing Ulcerative Colitis

Ulcerative colitis that lasts more than 8–10 years increases the risk of colon cancer. After 20 years, the risk may rise to 20–25%, especially if the disease is not well controlled.

If precancerous changes (dysplasia) or cancer is detected, surgery becomes necessary.

5. Emergency Situations

Severe attacks with uncontrolled bleeding or fulminant colitis that do not respond to intensive treatment also require timely surgery to save the patient’s life.

How is Ulcerative Colitis Surgery Performed?

The standard operation for ulcerative colitis is the removal of the colon and rectum. Depending on the patient’s condition, surgery may be done in two or three stages.

Most patients undergo a procedure called:

Ileal Pouch Surgery (J-Pouch / IPAA)

A pouch is created from the healthy small intestine

This pouch is connected to the anal canal

This allows patients to pass stool normally—without needing a permanent bag

This approach helps preserve the natural route of defecation and restores quality of life.

Benefits of Surgery for Ulcerative Colitis

✔ Potentially Curative Treatment

Once the colon and rectum (the diseased organs) are removed, the disease cannot come back.

✔ Freedom From Steroids & Immunosuppressive Drugs

Patients can stop taking medications that weaken immunity and cause multiple side effects.

✔ Long-Term Relief From Symptoms

More than 95% of patients experience long-term improvement with very good quality of life.

✔ Low Risk of Complications in Expert Hands

About 95–99% of patients do very well after surgery, especially when operated on by an experienced GI and colorectal surgeon.

Some patients may have occasional diarrhea episodes, but these are manageable medically and rarely require further steroids.

Is Surgery the Right Option for You?

Not every patient with ulcerative colitis needs surgery. But for the right patients, it offers:

• A permanent cure
• Improved quality of life
• Freedom from years of medication
• Reduced cancer risk

If you have long-standing UC, persistent symptoms, dependency on steroids, or concerns about cancer risk, an evaluation by a specialist colorectal surgeon is essential.

 Consult Dr. Vivek Mangla — Ulcerative Colitis & Colorectal Surgery Specialist in Delhi-NCR

Dr. Vivek Mangla is one of Delhi-NCR’s most trusted GI, HPB & colorectal surgeons, with extensive experience in treating complex ulcerative colitis cases and performing ileoanal pouch surgery with excellent outcomes.

To discuss whether surgery is the right option for your ulcerative colitis, book a consultation today.

A healthier, symptom-free future may be just a call away.