Will colon surgery increase my risk for heart disease?

Question

Hello doctor,

I was diagnosed with ulcerative colitis two years ago, and my gastroenterologist recently told me that my disease has progressed despite being on biologics, and I may need to consider surgery to remove my colon. I have been on a biologic injection for fourteen months, and while it helped initially, the inflammation has returned, and my last colonoscopy showed extensive active disease throughout my entire colon. I also have high blood pressure, and my cardiologist has warned me that major abdominal surgery carries significant cardiovascular risk for me specifically.

I want to understand exactly what removing my colon means for my daily life.
Will I need a permanent stoma bag?
How does my heart condition change the surgical risk calculation that my doctors are presenting to me?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand why this situation feels difficult. When ulcerative colitis remains active despite advanced medications, including biologic therapy, surgery may be considered as a definitive treatment. In ulcerative colitis, the disease is limited to the colon, so removing the colon can eliminate the source of inflammation when medical therapy fails.

The operation usually performed is a colectomy, often combined with a reconstruction called Ileal IPAA (ileal pouch–anal anastomosis). In this procedure, the diseased colon is removed, and a pouch is created from the small intestine and connected to the anus. This allows stool to pass normally without a permanent external bag. Many patients who undergo this surgery have four to six bowel movements per day, which is generally manageable.

In some cases, surgeons create a temporary ileostomy (a stoma bag on the abdomen) for several months while the pouch heals. For most people, it is temporary, though a permanent stoma may be required if pouch surgery is not suitable due to medical factors.

Regarding your heart condition and hypertension, major abdominal surgery does carry additional cardiovascular risk. Before surgery, doctors usually perform a preoperative cardiac evaluation, sometimes including stress testing and medication optimization. Good blood pressure control and coordination between the gastroenterologist, surgeon, anesthesiologist, and cardiologist are essential to minimize risk.

Although surgery sounds daunting, many patients with severe ulcerative colitis experience major improvement in quality of life afterward, because the chronic bleeding, pain, and inflammation are removed. The decision ultimately depends on balancing the risks of surgery against the ongoing impact and complications of uncontrolled disease.

A detailed discussion with your gastroenterologist and colorectal surgeon can help determine whether surgery or trying another advanced therapy is the safest and most effective path for you.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.