State-of-the-art surgery for ulcerative colitis

Abstract

Ulcerative colitis (UC) is an autoimmune-mediated colitis which can present in varying degrees of severity and increases the individual’s risk of developing colon cancer. While first-line treatment for UC is medical management, surgical treatment may be necessary in up to 25–30% of patients. With an increasing armamentarium of biologic therapies, patients are presenting for surgery much later in their course, and careful understanding of the complex interplay of the disease, its management, and the patient’s overall health is necessary when considering he appropriate way in which to address their disease surgically. Surgery is generally a total proctocolectomy either with pelvic pouch reconstruction or permanent ileostomy; however, this may need to be spread across multiple procedures given the complexity of the surgery weighed against the overall state of the patient’s health. Minimally invasive surgery, employing either laparoscopic, robotic, or transanal laparoscopic approaches, is currently the preferred approach in the elective setting. There is also some emerging evidence that appendectomy may delay the progression of UC in some individuals. Those who treat these patients surgically must also be familiar with the numerous potential pitfalls of surgical intervention and have plans in place for managing problems such as pouchitis, cuffitis, and anastomotic complications.

How the Western Diet Thwarts the Epigenetic Efforts of Gut Microbes in Ulcerative Colitis and Its Association with Colorectal Cancer

“…Surgery is introduced when therapeutic approaches fail (or corticosteroid dependence is indicated) or in the case of colonic dysplasia or cancer [ 65 ]. Approximately 10% to 15% of patients require surgical management of their disease [ 66 , 67 ].…”

Intracorporeal Ileal Pouch Anal Anastomosis after Fully Laparoscopic Total Proctocolectomy with Transanal Specimen Extraction

“…Laparoscopic approach has gained wide consensus for TP among colorectal surgeons, but a small laparotomy is usually performed to extract the specimen and to create the ileal pouch manually before the mechanical IPAA. [1][2][3] In this video, we present a step-by-step technique for total intracorporeal IPAA during laparoscopic TP with transanal specimen extraction in a case of a young woman affected by familiar adenomatous polyposis.…”

“…Laparoscopic approach has gained wide consensus for TP among colorectal surgeons, but a small laparotomy is usually performed to extract the specimen and to create the ileal pouch manually before the mechanical IPAA. 1–3…”

Perspectivas terapêuticas das doenças inflamatórias intestinais

“…Na colite ulcerativa as indicações mais comuns de operação urgente são: colite fulminante, megacólon tóxico, hemorragia descontrolada, perfuração e falha de medicação. Enquanto na DC as indicações mais comuns de urgência são obstrução e perfuração intestinal, sangramento descontrolado, fístula e abscesso (SPINELLI et al, 2018;VEAUTHIER;HORNECKER, 2018;LIU;EISENSTEIN, 2021).…”