Concierge colorectal surgery · London
Colectomy with ileorectal anastomosis, by a consultant colorectal surgeon.
A total or subtotal colectomy that removes the entire colon and joins the ileum directly to the rectum — done by a specialist IBD and polyposis surgeon, with IPAA and end-ileostomy honestly discussed before you commit.
Why patients choose us
- 01
A consultant colorectal surgeon, in theatre
Not a generalist and not a training list. A named colorectal surgeon in a proper theatre, with a specialist stoma and IBD team behind them.
- 02
IPAA and end ileostomy on the table
For some patients an ileal pouch (J-pouch) or an end ileostomy is the better answer. We say so before you commit to an IRA.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private colectomy with IRA costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
Laparoscopic total colectomy with IRA in our network: £18,000–£28,000, home in 5–8 nights.
| Procedure | Indicative range | Theatre time | Hospital stay |
|---|---|---|---|
| Laparoscopic total colectomy with IRA | £18,000–£28,000 | 3–5 hr | 5–8 nights |
| Open total colectomy with IRA | £16,000–£24,000 | 3–4 hr | 7–10 nights |
| Subtotal colectomy with IRA | £15,000–£22,000 | 3–4 hr | 5–8 nights |
| Ileal pouch-anal anastomosis (IPAA) | £22,000–£35,000 | 4–6 hr | 7–10 nights |
| End ileostomy (proctocolectomy) | £20,000–£30,000 | 4–5 hr | 7–10 nights |
| Consultation and MDT review | £300–£500 | 45 min | Same visit |
Prices vary by clinic, by which surgeon does the case, by laparoscopic vs open approach, and by whether a defunctioning ileostomy is formed. We come back with a firm quote within one working day.
The problem
The right surgeon, the right operation, the right rectum.
IRA, IPAA and end ileostomy are three very different lives. Which one fits depends on your diagnosis, your rectum, your fertility plans and your appetite for surveillance — not on the surgeon’s habit.
-
Not sure it’s an IRA?
A J-pouch or an end ileostomy might be safer. We put the pros and cons on paper before you commit.
-
Worried about function?
Four to six stools a day is normal after IRA — a specialist stoma nurse and dietitian make that manageable.
-
Want it done properly?
A named colorectal surgeon with high-volume IBD and polyposis practice, and a clear rectal surveillance plan from day one.
The journey
From enquiry to surveillance — what happens, in order.
One clinician from first message to review — and a rectal surveillance pathway that outlives the operation.
Phase 1 · Before surgery
Concierge, off-stage for you
Phase 2 · Admission
Theatre and ward, 5–8 nights
Phase 3 · After
Recovery and surveillance
- 01
Before
You tell us what is going on
A short, confidential form. Diagnosis (FAP, UC, Crohn’s, slow-transit constipation, tumour), symptoms and any previous surgery.
- 02
Before
We come back with a recommendation
Within one working day: the right operation (IRA, IPAA or end ileostomy), the right surgeon, and an indicative price.
- 03
Before
Pre-assessment and MDT review
Colonoscopy, imaging, anorectal function testing where relevant, and MDT discussion before a date is set. Fertility counselling for women of reproductive age.
- 04
Admission
Admission and surgery
Laparoscopic or open total/subtotal colectomy with ileorectal anastomosis under general anaesthetic. Usually 3–5 hours in theatre.
- 05
Admission
Recovery on the ward
Enhanced recovery protocol — early mobilisation, sips the same evening, food the next day. A defunctioning ileostomy is sometimes used and reversed later.
- 06
After
Home in 5–8 days
Discharge once eating, drinking, mobile and bowels are working. Written aftercare and 24/7 contact for the first fortnight.
- 07
After
Follow-up and surveillance
Clinic review at 2 and 6 weeks. Rectal surveillance every 6–12 months for life, because the rectum is still there.
Typical enquiry to surgery: 3–6 weeks. Return to work: 6–12 weeks. Rectal surveillance: indefinite.
When it helps
When colectomy with IRA is the right operation.
The diagnoses where an IRA earns its place — and the one situation where it never should.
-
Familial adenomatous polyposis (FAP)
Where the rectum is relatively spared, an IRA removes the polyp-bearing colon while keeping the rectum and avoiding a pouch.
-
Ulcerative colitis with rectal sparing
For UC patients who want to avoid a J-pouch and whose rectum is not badly affected — IRA preserves rectal function.
-
Slow-transit constipation
Refractory constipation with confirmed slow transit and normal anorectal function — IRA is the definitive operation.
-
Synchronous colonic tumours
Multiple cancers or high-risk polyps across the colon — a single operation clears them all while preserving the rectum.
-
Crohn’s colitis with rectal sparing
Selected Crohn’s patients with pancolonic disease and a spared rectum can avoid a permanent stoma with an IRA.
-
Colonic inertia after failed medical care
When laxatives, biofeedback and prokinetics have all failed and transit studies confirm colonic inertia.
-
HNPCC / Lynch syndrome
Selected Lynch-syndrome patients with a colon cancer may choose an extended resection with IRA to reduce metachronous risk.
-
Red flag: rectal disease or dysplasia
Active rectal inflammation, dysplasia or a low rectal cancer rules out an IRA — an IPAA or proctocolectomy is safer.
Procedure options
IRA is one of three answers.
What each option on the table actually involves — including the alternatives to IRA, and the second-stage operation that sometimes follows.
-
Laparoscopic total colectomy + IRA
Keyhole removal of the entire colon with the ileum joined to the upper rectum. Faster recovery, smaller scars, the default where feasible.
-
Open total colectomy + IRA
A midline incision — used where laparoscopy is not safe (adhesions, bulky tumour, severe inflammation).
-
Subtotal colectomy + IRA
A short segment of sigmoid is left with the rectum. Useful in emergency colitis or when the sigmoid is healthy and mobile.
-
Ileal pouch-anal anastomosis (IPAA)
The alternative for UC and FAP with rectal disease — a J-shaped reservoir made from ileum joined to the anus. Better cancer prevention, more stools per day.
-
End ileostomy (proctocolectomy)
The colon and rectum are removed and the ileum brought out as a permanent stoma. The definitive option where pouch and IRA are not safe.
-
Defunctioning loop ileostomy
A temporary stoma sometimes made at the same time as the IRA to protect the join — reversed at 8–12 weeks.
-
Completion proctectomy (later)
Removal of the retained rectum at a later date if disease, dysplasia or a cancer develops. Converts IRA to an end ileostomy or a pouch.
-
Consultation and MDT only
An honest, unhurried second opinion on which operation fits — no obligation to proceed.
Our vetted London network
A small panel of colorectal surgeons, we picked them.
Consultant colorectal surgeons in central London with high-volume IBD, FAP and slow-transit constipation practice. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every surgeon in our network.
-
Consultant colorectal surgeons with high-volume IBD and polyposis practice
-
Access to a specialist IBD, genetics and stoma nurse team
-
IPAA and end-ileostomy offered by the same surgeon, so the recommendation is unbiased
-
Formal rectal surveillance pathway agreed before discharge
Safety and red flags
What to plan for — honestly.
Colectomy with IRA is a major operation with a clear complication profile. The things worth knowing are the anastomotic leak risk, the ongoing rectal surveillance, and the fertility conversation for younger women.
-
Anastomotic leak (2–5%)
The commonest serious complication. Fever, abdominal pain and a rising CRP in the first week means a same-day CT scan and, sometimes, a return to theatre.
-
4–6 loose stools a day
Once healed, most patients settle at four to six semi-formed motions a day. Loperamide, fibre and diet control the rest.
-
Ongoing rectal cancer risk
Because the rectum is retained, surveillance sigmoidoscopy every 6–12 months is non-negotiable — for FAP, UC and Lynch alike.
-
Completion proctectomy in 10–20%
Over 10–20 years a proportion of patients need the rectum removed for refractory proctitis, dysplasia or cancer.
-
Dehydration and electrolyte loss
High-output stools in the first weeks can dehydrate you. Oral rehydration solutions, not plain water, are the answer.
-
Faecal urgency and incontinence
Some patients get urgency or nighttime leakage, especially with a shorter rectal stump — biofeedback and diet help most.
-
Adhesive small-bowel obstruction
A 5–10% lifetime risk after any major abdominal surgery — worth knowing about, rarely serious.
-
Fertility impact in women
Pelvic surgery reduces natural fertility. Egg or embryo freezing before surgery is discussed with every woman of reproductive age.
-
Proctitis in the retained rectum
For UC patients, inflammation of the remaining rectum can flare — treated medically, and rarely enough to need proctectomy.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whether it was laparoscopic or open, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and operation performed
Why the operation was done — FAP, UC, slow transit, tumour — and exactly which resection and anastomosis were made.
- 02 Technique
Approach and anastomosis
Laparoscopic or open, stapled or hand-sewn ileorectal join, and whether a defunctioning ileostomy was formed.
- 03 Findings
Pathology and any incidental findings
The histology of the colon specimen — polyp count, dysplasia, any cancer, margins and lymph nodes.
- 04 Impression
Function, surveillance and follow-up
Read this first: expected stool frequency, when rectal surveillance starts, and the plan for any residual disease.
Recognised by major UK insurers
Cover for colectomy with IRA is usually funded when medically indicated (FAP, UC, tumour). Cover for slow-transit constipation varies by insurer. We confirm cover in writing before booking.
Frequently asked
Everything we get asked about colectomy with IRA.
Quick answers on bowel function, fertility, surveillance, and how IRA compares with a J-pouch and an end ileostomy.
-
Why choose an ileorectal anastomosis over a J-pouch?
An IRA is a single, shorter operation with better bowel function (fewer stools, less urgency) and better fertility outcomes for women. The trade-off is an ongoing rectal cancer risk that needs lifelong surveillance. A J-pouch removes almost all the at-risk tissue but with more stools per day and a higher chance of pouchitis.
-
How many stools per day will I have after an IRA?
Most patients settle at four to six semi-formed motions per day, sometimes with a nighttime motion in the first months. Loperamide, a low-residue diet in the early weeks and fibre thereafter make this manageable for the vast majority.
-
Do I need a stoma after this operation?
Usually no permanent stoma. Some surgeons form a temporary defunctioning loop ileostomy to protect the ileorectal join, reversed at eight to twelve weeks. A permanent stoma is only needed if the operation is converted to an end ileostomy.
-
How much does a private colectomy with IRA cost in London?
Roughly £18,000–£28,000 for a laparoscopic total colectomy with IRA and £15,000–£22,000 for a subtotal. IPAA runs £22,000–£35,000, end ileostomy £20,000–£30,000. We come back with a firm quote within one working day.
-
What are the alternatives to an IRA?
Ileal pouch-anal anastomosis (J-pouch), end ileostomy after proctocolectomy, or, for slow-transit constipation, continuing medical therapy with sacral nerve stimulation. The right answer depends on your diagnosis, your rectum and your priorities.
-
When can I go back to work and exercise?
Desk work at four to six weeks, heavy manual work at eight to twelve. Light walking from day one; gym and running from six weeks. Core-heavy exercise waits three months to protect the abdominal wall.
-
Will this affect my fertility?
Yes — any pelvic surgery reduces natural fertility in women, though less than an IPAA. Egg or embryo freezing before surgery is offered to every woman of reproductive age. For men, sexual function is usually preserved because the pelvic nerves are not routinely dissected.
-
How often do I need surveillance of the retained rectum?
Rigid or flexible sigmoidoscopy every six to twelve months for life, indefinitely. The rectum is still at risk of polyps and cancer — for FAP and Lynch this is the whole point of preserving it, so surveillance is non-negotiable.
-
What are the warning signs after surgery?
Fever above 38°C, spreading abdominal pain, a swollen tender abdomen, no stool or wind after the first days, heavy rectal bleeding, or the wound turning red and hot — all warrant same-day contact with the team or A&E.
-
Can the operation be reversed?
Not really — the colon does not grow back. What can be revised is the rectal end: if the retained rectum causes trouble later, a completion proctectomy with an IPAA or end ileostomy is done as a second stage.
Sources and further reading
- Association of Coloproctology of Great Britain and Ireland (ACPGBI). Guidelines on the management of familial adenomatous polyposis and inflammatory bowel disease.
- American Society of Colon and Rectal Surgeons (ASCRS). Clinical practice guidelines for ulcerative colitis and hereditary colorectal cancer.
- European Society of Coloproctology (ESCP). Position statements on restorative proctocolectomy and ileorectal anastomosis.
- St Mark’s Hospital, London. Patient information on colectomy and IRA.
Last reviewed 2026-07-30. Next review 2027-07-30. Reviewer: Pulse Atlas Editorial Board, .
Related pages
Looking for something else?
-
Colectomy
The parent guide to colon-resection surgery.
Learn more -
Colonoscopy
The test that maps the colon before surgery.
Learn more -
Rigid sigmoidoscopy
The routine surveillance test for the retained rectum.
Learn more -
All tests & treatments
Every test and procedure we arrange.
Learn more -
Hypertension
Related condition guide.
Learn more -
Type 2 Diabetes
Related condition guide.
Learn more -
Blood Tests
Related diagnostic test.
Learn more -
Health Assessments Select
Related diagnostic test.
Learn more
In practice, in London
Booking colectomy with ileorectal anastomosis privately in London — what actually happens
For colectomy with ileorectal anastomosis, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. Public provision for colectomy with ileorectal anastomosis is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.
Once you’re in the private system for colectomy with ileorectal anastomosis, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For colectomy with ileorectal anastomosis in particular, we bias towards consultants who do this every week rather than every month.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see colectomy with ileorectal anastomosis — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.