#24 An introduction to IBD surgery - with consultant colorectal surgeon, Raj Mankotia

Send us Fan MailIn this episode of Wrestling the Octopus IBD, Nigel and Rachel talk with Mr Raj Mankotia, Consultant General and Colorectal Surgeon at Sandwell and West Birmingham Hospitals NHS Trust, to demystify the world of IBD-related surgery. With over 25 years’ experience, Raj talks us through first‑time elective or semi‑elective surgery for Crohn’s disease and ulcerative colitis - why it’s needed, what it involves and how patients can prepare for it.🔍 Key Topics Covered1. Why Patients Are Referred for SurgeryRaj explains the two main pathways:Elective referralsFailure of medical therapyPersistent symptoms (urgency, bleeding, weight loss, malnutrition)Pre‑cancerous changes or cancer found on surveillance colonoscopyEmergency referralsSevere inflammationBleedingPerforation2. “Can I choose surgery instead of medication?”Some patients doing well on medication may still prefer surgery. Raj explains:This is not a routine pathwayDecisions are individualisedCrohn’s patients will still need maintenance therapy after surgery3. Fear of Surgery & Fear of StomasA major theme of the episode.Raj discusses:How stoma decisions are made before surgery, not as a surpriseThe role of stoma nurses, psychologists and IBD teams in preparing patientsWhy emergency surgery often requires a temporary stoma4. Common MisconceptionsThe biggest one?“Everyone who has IBD surgery ends up with a permanent stoma.”Raj explains why this is not true, and how decisions depend on:Disease locationNutritional statusSteroid useHe also notes that many patients ultimately choose to keep their stoma because of the improvement in quality of life.5. Crohn’s Surgery: Ileal / Ileocaecal ResectionRaj outlines:Why this is the most common Crohn’s operationWhat the surgery involvesHe also discusses how recurrence rates have improved with modern biologics.6. Ulcerative Colitis SurgeryKey points include:Around 20–30% of UC patients may need surgeryEmergency surgery usually involves total colectomy, leaving the rectumReasons for leaving the rectum include protecting pelvic nerves (bladder and sexual function)7. J‑Pouch SurgeryRaj gives a realistic, balanced overview:Can be done laparoscopicallyA pouch is made from small bowel to mimic rectal functionOutcomes vary:~50% have excellent function~50% have more challenging function8. Preparing for Elective SurgeryPatients may be advised to:Optimise nutritionTaper steroidsStop smoking9. Hospital Stay & RecoveryTypical expectations:Enhanced recovery programmeDrinking on day 1, light food on day 2Early mobilisationRaj also explains postoperative ileus - why it happens and how it’s managed.10. What Patients Wish They’d KnownRaj shares reflections from his clinics:Many wish they’d had surgery earlierMany are surprised by how much better they feelSome who had emergency surgery and complications question the timing📩 Get in TouchIf you have questions for future surgical episodes or topics you’d like covered:📧 [email protected] Rachel at @bottomlineibdFollow Nigel at @crohnoid