Elective and Emergent Surgery in the Ulcerative Colitis Patient

DeLeon, Michelle; Stocchi, Luca

doi:10.1055/s-0042-1758134

Cited by 3 publications

(3 citation statements)

References 60 publications

(45 reference statements)

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“…During hospitalization, there should be frequent communication between the gastroenterologist responsible for the patient and the surgeon who will take over the patient in case of surgery. This collaboration will make it possible to make joint decisions about the time of surgery, the regulation of the received conservative treatment, but also the planning of a coordinated postoperative course[ 67 ]. Table 2 shows the indications for surgery in UC patients.…”

Section: Surgical Treatment Of Ucmentioning

confidence: 99%

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Triantafillidis

2024

World J Gastrointest Surg

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Treatment of ulcerative colitis (UC) and Crohn’s disease (CD) represents, in the majority of cases, a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience. During the last two decades, our pharmaceutical arsenal was significantly strengthened, especially after the introduction of the so-called biological agents, drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease. However, colectomy is still necessary for some patients with severe UC although smaller compared to the past, precisely because of the improvements achieved in the available conservative treatment. Nevertheless, surgeries to treat colon dysplasia and cancer are increasing to some extent. At the same time, satisfactory improvements in surgical techniques, the pre-and post-operative care of patients, as well as the selection of the appropriate time for performing the surgery have been noticed. Regarding patients with CD, the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease. On the other hand, the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible. This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view, the results of the emerging new techniques such as transanal surgery and robotics, as well as alternative operations to the classic ileo-anal-pouch anastomosis. The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature. The self-evident is emphasized, that is, to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era; the close cooperation of gastroenterologists with surgeons, pathologists, imaging, and nutritionists is of paramount importance.

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Section: Surgical Treatment Of Ucmentioning

confidence: 99%

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Triantafillidis

2024

World J Gastrointest Surg

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“…Patients with UC are at increased risk for developing colorectal cancer and most cases are thought to arise from dysplasia, making endoscopic surveillance the standard recommendation to detect dysplasia. As advancements have been made in medical therapies and endoscopic surveillance, the surgical management of dysplasia in UC has changed in parallel ( 26 - 28 ). Prior to advancements in endoscopy, most areas of visible dysplasia that were previously referred for surgery currently undergo endoscopic resection alone with close surveillance.…”

Section: Pouches For Dysplasia or Cancermentioning

confidence: 99%

“…Patients with UC found to have invasive colon or rectal cancer should undergo the same routine cancer staging followed by neoadjuvant/adjuvant therapy (if indicated) and surgery. In these patients, total proctocolectomy with or without IPAA is the standard recommendation to remove all tissue at risk for dysplasia/adenocarcinoma ( 26 , 28 ). Additionally, data has demonstrated the results of IPAA in these situations are satisfactory with good function and no different from those undergoing IPAA in the absence of dysplasia or cancer ( 29 ).…”

Section: Pouches For Dysplasia or Cancermentioning

confidence: 99%

Restorative pouch surgery following proctocolectomy for inflammatory bowel disease: past experience and future direction

Cohen¹,

Silvestri²,

Schwartzberg³

2023

Transl Gastroenterol Hepatol

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Major advancements in surgery for patients suffering proctocolitis from ulcerative colitis (UC) or selected patients with Crohn’s disease (CD) have emerged in a relatively short time. Historically, patients underwent a proctocolectomy with end ileostomy, however, a restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) was introduced in the late 1970s in the United Kingdom and gave patients the opportunity to avoid a permanent stoma. Initially designed as a hand-sewn “S” shaped pouch, with the invention of the linear stapler, a “J” shaped pouch was described in Japan, and subsequent advances in the United States largely contributed to the pelvic pouch’s evolution to the standard of care in the management of patients with inflammatory bowel disease (IBD). The procedure was then divided into different stages depending on the medical condition of the patient and minimally invasive techniques (laparoscopic & robotic surgery) have continued to advance the success of the operation. Unfortunately, pouch complications occur, and seem to be occurring at an increasing frequency with the adoption of minimally invasive surgery. The field of reoperative pouch surgery has emerged to offer patients the opportunity to restore their quality of life (QOL) without the need for a permanent ostomy. Many patients with signs of pouch failure such as pouchitis, fistulae, pain and obstruction are diagnosed with Crohn’s of the pouch, but many have mechanical complications that can be corrected with surgery, rather than offering pouch excision with a permanent ostomy (continent or traditional). Patients with Crohn’s may be offered an IPAA but they will not have success if they, like patients with UC, have mechanical complications leading to their pouch failure. Patients who undergo reoperative pouch surgery do well with an acceptable QOL.

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Saffron as a Promising Therapy for Inflammatory Bowel Disease

Rashid,

Saroya

et al. 2024

Nutrients

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Inflammatory bowel disease (IBD) is a chronic inflammatory illness of the gastrointestinal tract (GI), characterized by recurrent episodes of inflammation and tissue destruction. It affects an increasing number of individuals worldwide who suffer from Crohn’s disease (CD) or ulcerative colitis (UC). Despite substantial advances in understanding the underlying causes of IBD, the available treatments remain restricted and are sometimes accompanied by severe consequences. Consequently, there is an urgent need to study alternate therapeutic options. This review assesses the present drugs, identifies their limitations, and proposes the use of saffron, a natural plant with great therapeutic potential based on preclinical and clinical investigations. Saffron has gained attention for its potential therapeutic benefits in treating various ailments due to its established bioactive compounds possessing antioxidant and anti-inflammatory properties. This review covers how saffron impacts the levels of calprotectin, an inflammatory marker, for various inflammatory responses in multiple diseases including IBD. Data from clinical trials were assessed to determine the efficacy and safety of using saffron to counter inflammation in multiple diseases. Studies have shown that saffron may protect against inflammatory bowel disease (IBD) through several mechanisms by inhibiting pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6), reducing oxidative stress through antioxidant effects, enhancing mucosal barrier function by upregulating tight junction proteins, and modulating the gut microbiota composition to promote beneficial bacteria while suppressing pathogenic ones; these combined actions contribute to its therapeutic potential in managing and alleviating the symptoms of IBD. This will enable future research endeavors and expedite the translation of saffron-based interventions into clinical practice as a valuable adjunctive therapy or a potential alternative to conventional treatments, thereby enhancing the quality of life for individuals suffering from inflammatory diseases including IBD.

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Elective and Emergent Surgery in the Ulcerative Colitis Patient

Cited by 3 publications

References 60 publications

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Restorative pouch surgery following proctocolectomy for inflammatory bowel disease: past experience and future direction

Saffron as a Promising Therapy for Inflammatory Bowel Disease

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