Short-term Outcomes of Elective 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Does Laparoscopy Have Benefits?

Bong, Jun Woo; Yoon, Yong Sik; Lee, Jong Lyul; Kim, Chan Wook; Park, In Ja; Lim, Seok‐Byung; Yu, Chang Sik; Kim, Jin Cheon

doi:10.3393/ac.2019.03.29

Ann Coloproctol

2020

DOI: 10.3393/ac.2019.03.29

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Short-term Outcomes of Elective 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Does Laparoscopy Have Benefits?

Jun Woo Bong

Yong Sik Yoon

Jong Lyul Lee

et al.

Abstract: Original ArticleAnn Coloproctol 2020;36(1):41-47 https://doi.org/10. 3393/ac.2019.03.29 Purpose: This study aimed to compare the short-term outcomes of the open and laparoscopic approaches to 2-stage restorative proctocolectomy (RPC) for Korean patients with ulcerative colitis (UC). Methods: We retrospectively analyzed the medical records of 73 patients with UC who underwent elective RPC between 2009 and 2016. Patient characteristics, operative details, and postoperative complications within 30 days were co… Show more

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“…Bong et al [10] compared the short-term outcomes of the open and laparoscopic approaches to 2-stage RPC for patients suffering from refractory UC and UC with dysplasia. The patients in the laparoscopic surgery group had lower mean body mass index (P = 0.025), shorter bowel function recovery time (P = 0.004), and less postoperative day (POD) 1 and POD 7 pain (P = 0.029 and P = 0.027, respectively), than those in the open surgery group.…”

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Benefits of Elective Laparoscopic 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea

Park

Kang

2020

Ann Coloproctol

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EditorialAnn Coloproctol 2020;36(1):3-4 https://doi.org/10. 3393/ac.2020.02.05 Ulcerative colitis (UC) is a nonspecific inflammatory enteropathy characterized by bloody diarrhea accompanied by urgency and tenesmus. Approximately 15% of patients suffering UC develop acute attacks of severe colitis, and approximately 30% of these patients need colectomy [1]. Further, approximately 10% of patients first diagnosed with UC also need surgery [2]. Indications suggesting surgery for UC are as follows: (1) the major complication of acute severe ulcerative colitis (i.e., toxic megacolon, perforation, severe colorectal bleeding, multiple organ dysfunction syndrome);(2) refractory UC which includes both steroid dependency and immunomodulators, or biologic-refractory UC; (3) associated dysplasia and carcinoma [3].Surgical approaches for UC vary widely from the open subtotal colectomy with end ileostomy to a laparoscopic restorative proctocolectomy (RPC) according to the severity of disease. For the cases of elective surgery indicated for refractory UC or for UC patients with dysplasia who have favorable general conditions, the employment of laparoscopic surgery can be considered. However, for cases of severe UC and emergency surgery, the feasibility of employment of the laparoscopic approach remains controversial [4].Studies have compared the open-and laparoscopic surgical approaches for UC. Larson et al. [5] compared surgical groups that used laparoscopic restorative proctocolectomy (RPC) and open RPC among patients suffering from chronic UC and FAP. The laparoscopic group had a postoperative morbidity of 6% and the open group had 12%, which were not statistically different (P = 0.39). There were also no significant differences in terms of quality of life (P = 0.95). In a study conducted by Chung et al. [6], surgeons utilized laparoscopic-and open surgeries as the initial operation among the 3-stage RPC procedures for severe UC.When surgery types were compared to each other, the postoperative morbidity for the laparoscopic approach appeared significantly lower than open surgery (24% and 53%, respectively; P = 0.0386) together with a significantly shorter time of bowel function recovery (2.6 days and 5.5 days, respectively; P = 0.0001). In some studies, laparoscopic surgery appeared to require more time than open surgery [7][8][9].Bong et al.[10] compared the short-term outcomes of the open and laparoscopic approaches to 2-stage RPC for patients suffering from refractory UC and UC with dysplasia. The patients in the laparoscopic surgery group had lower mean body mass index (P = 0.025), shorter bowel function recovery time (P = 0.004), and less postoperative day (POD) 1 and POD 7 pain (P = 0.029 and P = 0.027, respectively), than those in the open surgery group. In terms of postoperative complications, there were no significant differences between groups. However, in regard to the appearance of ileus, the laparoscopic surgery patient group had significantly fewer cases of ileus than the open surgery group (7.7% vs. 27.7%, P...

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Benefits of Elective Laparoscopic 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea

Park

Kang

2020

Ann Coloproctol

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Patient-reported Outcome Measures in Ileoanal Pouch Surgery: a Systematic Review

Warsop,

Manzo,

et al. 2023

Journal of Crohn's and Colitis

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Objective To summarize frequency, type, and heterogeneity of Patient Reported Outcomes Measures (PROMs) in papers reporting on outcomes after Ileal Pouch Anal Anastomosis (IPAA). Background Prevalence of Ulcerative Colitis (UC) has risen in Western Countries, and 1 in 3 patients requires surgery. IPAA is a frequently performed procedures for UC, and a lack of standardization is manifest in reporting outcomes for Inflammatory Bowel Disease (IBD) despite the clear need for inclusion of PROMs as primary outcomes in IBD trials. Methods Scopus, Pubmed and Web of Science databases were searched from January 2010 to January 2023 for studies investigating outcomes in IPAA surgery. The primary outcome was the proportion of studies reporting outcomes for IPAA surgery for UC which included PROMs. Results The search identified a total of 8028 studies which, after deduplication and exclusion, were reduced to 79 articles assessing outcomes after IPAA surgery. 44 (55.7%) reported PROMs, with 23 including validated questionnaires and 21 papers using authors’ questions. 22 different PROMs were identified, with bowel function as the mostly investigated item. Majority of studies (67/79, 85%) were retrospective, only 14/79 (18%) prospective papers and only 2 (2.5%) randomized controlled trials. Conclusions Only half of the papers reviewed used PROMs. The main reported item is bowel function, whilst urogenital, social, and psychological function are the most neglected. There is lack of standardisation for use of PROMs in IPAA. Complexity of UC and of outcomes after IPAA demands a change in clinical practice and follow up given how crucial PROMs are, compared to their non-routinary use.

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Creation of an institutional preoperative checklist to support clinical risk assessment in patients with ulcerative colitis (UC) considering ileoanal pouch surgery

Alves Martins,

Shamsiddinova,

Alquaimi

et al. 2023

Frontline Gastroenterol

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BackgroundTotal proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of life. As such, patient selection is crucial to its success. The main aim of this paper is to present an institutional preoperative checklist to support clinical risk assessment and patient selection in those considering IPAA.MethodsA literature review was performed to identify the risk factors associated with surgical complications, decreased functional outcomes/quality of life, and pouch failure after IPAA. Based on this, a preliminary checklist was devised and modified through an iterative process. This was then evaluated by a consensus group comprising the pouch multidisciplinary team (MDT) core members.ResultsThe final preoperative checklist includes assessment for risk factors such as gender, advanced age, obesity, comorbidities, sphincteric impairment, Crohn’s disease and pelvic radiation therapy. In addition, essential steps in the decision-making process, such as pouch nurse counselling and discussion regarding surgical alternatives, are also included. The last step of the checklist is discussion at a dedicated pouch-MDT.DiscussionA preoperative checklist may support clinicians with the selection of patients that are suitable for pouch surgery. It also serves as a useful tool to inform the discussion of cases at the MDT meeting.

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Short-term Outcomes of Elective 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Does Laparoscopy Have Benefits?

Cited by 3 publications

References 30 publications

Benefits of Elective Laparoscopic 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea

Benefits of Elective Laparoscopic 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea

Patient-reported Outcome Measures in Ileoanal Pouch Surgery: a Systematic Review

Creation of an institutional preoperative checklist to support clinical risk assessment in patients with ulcerative colitis (UC) considering ileoanal pouch surgery

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