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Updates in Surgery
Published in: Updates in Surgery 2/2020

01-06-2020 | Ulcerative Colitis | Review Article

Modern surgery for ulcerative colitis

Authors: Brenda Murphy, Dara Oliver Kavanagh, Desmond Colm Winter

Published in: Updates in Surgery | Issue 2/2020

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Abstract

Ulcerative colitis (UC) is a chronic inflammatory disorder of poorly understood aetiology. While medical treatment is first-line management, approximately 10% of patients with UC will require a colectomy either as an emergency or elective procedure. There are multiple surgical options available in the current era and the choice of operation(s) is highly dependent on the clinical presentation, patient preference and individual surgeon or institutional practice. We present a review of modern surgical practices in ulcerative colitis, addressing some current controversies and diversities.
Literature
1.
2.
Lakatos PL (2006) Recent trends in the epidemiology of inflammatory bowel diseases: up or down? WJG 12(38):6102PubMed
3.
Manninen P, Karvonen AL, Huhtala H, Rasmussen M, Collin P (2010) The epidemiology of inflammatory bowel diseases in Finland. Scand J Gastroenterol 45(9):1063–1067PubMed
4.
Loftus CG, Loftus EV Jr, Harmsen SW, Zinsmeister AR, Tremaine WJ, Melton JL III, Sandborn WJ (2006) Update on the incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted County, Minnesota, 1940–2000. Inflamm Bowel Dis 13(3):254–261
5.
Khalil MA, Boutros M, Nedjar H, Morin N, Ghitulescu G, Vasilevsky CA, Gordon P, Rahme E (2018) Incidence rates and predictors of colectomy for ulcerative colitis in the era of biologics: results from a provincial database. J Gastrointest Surg 22(1):124–132PubMed
6.
Aratari A, Papi C, Clemente V, Moretti A, Luchetti R, Koch M, Capurso L, Caprilli R (2008) Colectomy rate in acute severe ulcerative colitis in the infliximab era. Digest Liver Dis 40(10):821–826
7.
Clemente V, Aratari A, Papi C, Vernia P (2016) Short term colectomy rate and mortality for severe ulcerative colitis in the last 40 years Has something changed? Digest Liver Dis 48(4):371–375
8.
Wanderås MH, Moum BA, Høivik ML, Hovde Ø (2016) Predictive factors for a severe clinical course in ulcerative colitis: results from population-based studies. World J Gastrointest Pharmacol Therap 7(2):235
9.
Leeds IL, Truta B, Parian AM, Chen SY, Efron JE, Gearhart SL, Safar B, Fang SH (2017) Early surgical intervention for acute ulcerative colitis is associated with improved postoperative outcomes. J Gastrointest Surg 21(10):1675–1682PubMedPubMedCentral
10.
Randall J, Singh B, Warren BF, Travis SPL, Mortensen NJ, George BD (2010) Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications. Br J Surg Incorp Eur J Surg Swiss Surg 97(3):404–409
11.
Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR (2003) Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 125(2):320–327PubMed
12.
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD (2019) ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol 114(3):384–413PubMed
13.
Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Feldman LS, Steele SR (2017) Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 60(8):761–784PubMed
14.
Probert CSJ, Hearing SD, Schreiber S, Kühbacher T, Ghosh S, Arnott IDR, Forbes A (2003) Infliximab in moderately severe glucocorticoid resistant ulcerative colitis: a randomised controlled trial. Gut 52(7):998–1002PubMedPubMedCentral
15.
Kaplan GG, McCarthy EP, Ayanian JZ, Korzenik J, Hodin R, Sands BE (2008) Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 134(3):680–687PubMed
16.
Hawley PR (1981) Conservative excision of the rectum in inflammatory bowel disease. Atlas Gen Surg 1:445–448
17.
Hawley PR (1988) Emergency surgery for ulcerative colitis. World J Surg 12(2):169–173PubMed
18.
Glotzer DJ (1980) Operation in inflammatory bowel disease: indications and type. Clin Gastroenterol 9(2):371–388PubMed
19.
Teeuwen PH, Stommel MW, Bremers AJ, Van Der Wilt GJ, De Jong DJ, Bleichrodt RP (2009) Colectomy in patients with acute colitis: a systematic review. J Gastrointest Surg 13(4):676PubMed
20.
Carter FM, McLeod RS, Cohen Z (1991) Subtotal colectomy for ulcerative colitis: complications related to the rectal remnant. Dis Colon Rectum 34(11):1005–1009PubMed
21.
Kyle SM, Steyn RS, Keenan RA (1992) Management of the rectum following colectomy for acute colitis. Aust N Z J Surg 62(3):196–199PubMed
22.
McKee RF, Keenan RA, Munro A (1995) Colectomy for acute colitis: is it safe to close the rectal stump? Int J Colorect Dis 10(4):222–224
23.
Wøjdemann M, Wettergren A, Hartvigsen A, Myrhøj T, Svendsen LB, Bülow S (1995) Closure of rectal stump after colectomy for acute colitis. Int J Colorect Dis 10(4):197–199
24.
Ng RL, Davies AH, Grace RH, Mortensen NJ (1992) Subcutaneous rectal stump closure after emergency subtotal colectomy. Br J Surg 79(7):701–703PubMed
25.
Trickett JP, Tilney HS, Gudgeon AM, Mellor SG, Edwards DP (2005) Management of the rectal stump after emergency sub-total colectomy: which surgical option is associated with the lowest morbidity? Colorect Dis 7(5):519–522
26.
Dunker MS, Bemelman WA, Slors JF, Van Hogezand RA, Ringers J, Gouma DJ (2000) Laparoscopic-assisted vs open colectomy for severe acute colitis in patients with inflammatory bowel disease (IBD). Surg Endosc 14(10):911–914PubMed
27.
Marcello PW, Milsom JW, Wong SK, Brady K, Goormastic M, Fazio VW (2001) Laparoscopic total colectomy for acute colitis. Dis Colon Rectum 44(10):1441–1445 (Faster recovery i.e. length of stay and return to bowel function) PubMed
28.
Seshadri PA, Poulin EC, Schlachta CM, Cadeddu MO, Mamazza J (2001) Does a laparoscopic approach to total abdominal colectomy and proctocolectomy offer advantages? Surg Endosc 15(8):837–842PubMed
29.
Bell RL, Seymour NE (2002) Laparoscopic treatment of fulminant ulcerative colitis. Surg Endosc Other Intervent Tech 16(12):1778–1782
30.
Ouaïssi M, Alves A, Bouhnik Y, Valleur P, Panis Y (2006) Three-step ileal pouch-anal anastomosis under total laparoscopic approach for acute or severe colitis complicating inflammatory bowel disease. J Am Coll Surg 202(4):637–642PubMed
31.
Fowkes L, Krishna K, Menon A, Greenslade GL, Dixon AR (2008) Laparoscopic emergency and elective surgery for ulcerative colitis. Colorect Dis 10(4):373–378
32.
Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y (2007) Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery 141(5):640–644PubMed
33.
34.
Yu CS, Pemberton JH, Larson D (2000) Ileal pouch-anal anastomosis in patients with indeterminate colitis. Dis Colon Rectum 43(11):1487–1496PubMed
35.
36.
Waljee A, Waljee J, Morris AM, Higgins PD (2006) Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut 55(11):1575–1580PubMedPubMedCentral
37.
Gorgun E, Remzi FH, Goldberg JM, Thornton J, Bast J, Hull TL, Loparo B, Fazio VW (2004) Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: a study of 300 patients. Surgery 136(4):795–803PubMed
38.
Lepistö A, Sarna S, Tiitinen A, Järvinen HJ (2007) Female fertility and childbirth after ileal pouch–anal anastomosis for ulcerative colitis. Br J Surg Incorp Eur J Surg Swiss Surg 94(4):478–482
39.
40.
Leijonmarck CE, Löfberg R, Öst Å, Hellers G (1990) Long-term results of ileorectal anastomosis in ulcerative colitis in Stockholm County. Dis Colon Rectum 33(3):195–200PubMed
41.
da Luz Moreira A, Kiran RP, Lavery I (2010) Clinical outcomes of ileorectal anastomosis for ulcerative colitis. Br J Surg 97(1):65–69
42.
Scoglio D, Ali UA, Fichera A (2014) Surgical treatment of ulcerative colitis: ileorectal vs ileal pouch-anal anastomosis. WJG 20(37):13211PubMed
43.
deZeeuw S, Ali UA, Donders RA, Hueting WE, Keus F, van Laarhoven CJ (2012) Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Colorect Dis 27(7):843–853
44.
45.
Singh P, Bhangu A, Nicholls RJ, Tekkis P (2013) A systematic review and meta-analysis of laparoscopic vs open restorative proctocolectomy. Colorect Dis 15(7):e340–e351
46.
Leblanc F, Senagore AJ, Ellis CN, Champagne BJ, Augestad KM, Neary PC, Delaney CP, Group, C.S.T (2010) Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models. J Surg Educ 67(4):200–204PubMed
47.
Rivadeneira DE, Marcello PW, Roberts PL, Rusin LC, Murray JJ, Coller JA, Schoetz DJ (2004) Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study. Dis Colon Rectum 47(9):1371–1376PubMed
48.
Tsuruta M, Hasegawa H, Ishii Y, Endo T, Ochiai H, Hibi T, Kitagawa Y (2009) Hand-assisted versus conventional laparoscopic restorative proctocolectomy for ulcerative colitis. Surg Laparosc Endosc Percutan Tech 19(1):52–56PubMed
49.
50.
van de Buck van Overstraeten A, Wolthuis AM, D’Hoore A (2016) Transanal completion proctectomy after total colectomy and ileal pouch-anal anastomosis for ulcerative colitis: a modified single stapled technique. Colorect Dis 18(4):O141–O144
51.
Zaghiyan K, Warusavitarne J, Spinelli A, Chandrasinghe P, Di Candido F, Fleshner P (2018) Technical variations and feasibility of transanal ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified across continents. Tech Coloproctol 22(11):867–873PubMed
52.
de Lacy FB, van Laarhoven JJ, Pena R, Arroyave MC, Bravo R, Cuatrecasas M, Lacy AM (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 32(5):2442–2447PubMed
53.
van Overstraeten ADB, Mark-Christensen A, Wasmann KA, Bastiaenen VP, Buskens CJ, Wolthuis AM, Vanbrabant K, D’hoore A, Bemelman WA, Tottrup A, Tanis PJ (2017) Transanal versus transabdominal minimally invasive (completion) proctectomy with ileal pouch-anal anastomosis in ulcerative colitis: a comparative study. Ann Surg 266(5):878–883
54.
Coffey JC, O’Leary DP (2016) The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 1(3):238–247PubMed
55.
Heald RJ (1979) A new approach to rectal cancer. Br J Hosp Med 22:277–281PubMed
56.
Hicks CW, Hodin RA, Savitt L, Bordeianou L (2014) Does intramesorectal proctectomy with rectal eversion affect postoperative complications compared to standard total mesorectal excision in patients with ulcerative colitis? J Gastrointest Surg 18(2):385–390PubMed
57.
Nally DM, Kavanagh DO, Winter DC (2018) Close rectal dissection in benign diseases of the rectum: a review. The Surgeon 17:119–126PubMed
58.
Bartels SAL, Gardenbroek TJ, Aarts M, Ponsioen CY, Tanis PJ, Buskens CJ, Bemelman WA (2015) Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch–anal anastomosis. Br J Surg 102(3):281–287PubMed
59.
Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238(2):229PubMedPubMedCentral
60.
MacRae HM, McLeod RS, Cohen Z, O’connor BI, Ton EN (1997) Risk factors for pelvic pouch failure. Dis Colon Rectum 40(3):257–262PubMed
61.
Remzi FH, Fazio VW, Gorgun E, Ooi BS, Hammel J, Preen M, Church JM, Madbouly K, Lavery IC (2006) The outcome after restorative proctocolectomy with or without defunctioning ileostomy. Dis Colon Rectum 49(4):470–477PubMed
62.
Ziv Y, Church JM, Fazio VW, King TM, Lavery IC (1996) Effect of systemic steroids on ileal pouch-anal anastomosis in patients with ulcerative colitis. Dis Colon Rectum 39(5):504–508PubMed
63.
Cohen Z, McLeod RS, Stephen W, Stern HS, O’connor B, Reznick R (1992) Continuing evolution of the pelvic pouch procedure. Ann Surg 216(4):506PubMedPubMedCentral
64.
Wexner SD, Taranow DA, Johansen OB, Itzkowitz F, Daniel N, Nogueras JJ, Jagelman DG (1993) Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum 36(4):349–354PubMed
65.
Eshuis EJ, Al Saady RL, Stokkers PC, Ponsioen CY, Tanis PJ, Bemelman WA (2013) Previous infliximab therapy and postoperative complications after proctocolectomy with ileum pouch anal anastomosis. J Crohns Colitis 7:142–149PubMed
66.
Billioud V, Ford AC, Tedesco ED, Colombel JF, Roblin X, Peyrin-Biroulet L (2013) Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohn’s Colitis 7(11):853–867
67.
Lee GC, Deery SE, Kunitake H, Hicks CW, Olariu AG, Savitt LR, Ananthakrishnan AN, Ricciardi R, Hodin RA, Bordeianou LG (2019) Comparable perioperative outcomes, long-term outcomes, and quality of life in a retrospective analysis of ulcerative colitis patients following 2-stage versus 3-stage proctocolectomy with ileal pouch-anal anastomosis. Int J Colorect Dis 34:1–9
68.
Ryan DP, Doody DP (2011) Restorative proctocolectomy with and without protective ileostomy in a pediatric population. J Pediatr Surg 46(1):200–203PubMed
69.
Zittan E, Wong-Chong N, Ma GW, McLeod RS, Silverberg MS, Cohen Z (2016) Modified two-stage ileal pouch-anal anastomosis results in lower rate of anastomotic leak compared with traditional two-stage surgery for ulcerative colitis. J Crohn’s Colitis 10(7):766–772
70.
Swenson BR, Hollenbeak CS, Poritz LS, Koltun WA (2005) Modified two-stage ileal pouch-anal anastomosis: equivalent outcomes with less resource utilization. Dis Colon Rectum 48(2):256–261PubMed
71.
Traynor MD Jr, Yonkus J, Moir CR, Klinkner DB, Potter DD Jr (2019) Altering the traditional approach to restorative proctocolectomy after subtotal colectomy in pediatric patients. J Laparoendosc Adv Surg Tech 29(10):1207–1211
72.
Tuckson W, Lavery I, Fazio V, Oakley J, Church J, Milsom J (1991) Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation. Am J Surg 161(1):90–96PubMed
73.
Luukkonen P, Järvinen H (1993) Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy: a prospective. Randomized study. Arch Surg 128(4):437–440PubMed
74.
Tsunoda A, Nicholls RJ (1991) Prospective randomized trial comparing anal function after hand sewn ileoanal anastomosis with mucosectomy versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy. Br J Surg 78(4):430–434PubMed
75.
Lovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, Nicholls RJ, Fazio VW, Tekkis PP (2006) A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 244(1):18PubMedPubMedCentral
76.
Winter DC, Murphy A, Kell MR, Shields CJ, Redmond HP, Kirwan WO (2004) Perioperative topical nitrate and sphincter function in patients undergoing transanal stapled anastomosis: a randomized, placebo-controlled, double-blinded trial. Dis Colon Rectum 47(5):697–703PubMed
77.
Nicholls RJ, Pezim ME (1985) Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br J Surg 72(6):470–474PubMed
78.
Lovegrove RE, Heriot AG, Constantinides V, Tilney HS, Darzi AW, Fazio VW, Nicholls RJ, Tekkis PP (2007) Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorect Dis 9(4):310–320
79.
Simillis C, Afxentiou T, Pellino G, Kontovounisios C, Rasheed S, Faiz O, Tekkis PP (2018) A systematic review and meta-analysis comparing adverse events and functional outcomes of different pouch designs after restorative proctocolectomy. Colorect Dis 20:664–675
80.
McCormick PH, Guest GD, Clark AJ, Petersen D, Clark DA, Stevenson AR, Lumley JW, Stitz RW (2012) The ideal ileal-pouch design: a long-term randomized control trial of J-vs W-pouch construction. Dis Colon Rectum 55(12):1251–1257PubMed
Metadata
Title
Modern surgery for ulcerative colitis
Authors
Brenda Murphy
Dara Oliver Kavanagh
Desmond Colm Winter
Publication date
01-06-2020
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 2/2020
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-020-00719-4

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