Key Concepts

• Multidisciplinary management and early surgical referral are crucial in the management of ulcerative colitis patients with moderate to severe colitis. While dysplasia screening and management is changing, surgical referral remains a cornerstone in the management of multifocal and high-grade dysplasia.
• Ileal pouch-anal anastomosis is the standard surgery for medically refractory disease, cancer, or dysplasia. One, two, or three-stage surgery may be chosen and tailored to various patient factors including preoperative nutritional status, corticosteroid use, and intraoperative factors.
• Alternative approaches such as total proctocolectomy with end ileostomy, continent ileostomy, and ileorectal anastomosis are options that may be considered in select patients.
• Long-term functional outcomes of patients undergoing surgery for ulcerative colitis including bowel, sexual, and urinary function, as well as fertility preservation, are important considerations and should be discussed preoperatively and monitored closely in the postoperative setting.