Minimally Invasive Pouch Surgery for Ulcerative Colitis: Is There a Benefit in Staging?

Abstract

In our practice, we have selectively applied a 3-stage laparoscopic surgical approach to restorative proctocolectomy in patients with ulcerative colitis who are receiving aggressive medical therapy in an attempt to minimize perioperative complications. This strategy appears efficacious, and short-term outcomes compare favorably with those following a 2-stage approach.

Robotic-Assisted Proctectomy for Inflammatory Bowel Disease: A Case-Matched Comparison of Laparoscopic and Robotic Technique

“…This strategy involves a laparoscopic total abdominal colectomy (TAC) followed by either laparoscopic IPAA in UC or laparoscopic completion proctectomy (CP) in CD. 3 With growing experience in minimally invasive surgery, we now routinely employ laparoscopic surgical technique when performing TAC and proctectomy, even in complex IBD patients. 4,5 Ongoing innovation in minimally invasive surgery has led to advances in surgical robotic technology.…”

Inflammatory Bowel Disease: Perioperative Pharmacological Considerations

“…6,7 The perioperative management of medication will not differ between patients with IBD undergoing GI vs non-GI surgeries (eg, orthopedic procedures) because, regardless of the type of procedure, the adequate control of IBD is paramount given its systemic implications.…”

“…7,89 In a recent review, Beddy et al 5 questioned whether it was justifiable to delay surgery in patients who have recently been administered infliximab or to create a proximal diverting stoma purely to deliver biologic medications. Currently, we do not recommend the discontinuation of immunomodulator therapy with anti-TNF agents in the perioperative setting.…”

Total Abdominal Colectomy for Refractory Ulcerative Colitis. Surgical Treatment in Evolution

“…3 ileostomy taken down. Briefly, at the beginning of the second procedure the ileostomy was mobilized and the pouch was constructed extracorporeally, as previously described 39 and the center rod and anvil of the circular stapler was secured at the apex of the pouch.…”

“…1,2 After reviewing our own experience we have adopted a staged strategy for these patients that offers a significant reduction in morbidity and complications and improvement in short-term outcomes. 3 The first stage is a total abdominal colectomy (TAC) that allows for fast recovery and improvement of patients' general and nutritional status and since laparoscopy has been shown to be safe and effective it has become the preferred strategy in our practice. [4][5][6][7][8][9][10] Considering the magnitude of the procedure and the poor quality of severely inflamed tissues, a hand-assisted technique has been popularized as a valuable alternative to laparoscopic-assisted surgery, for a faster and safer procedure, still maintaining the benefit of laparoscopy.…”