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

Abstract

Single incision laparoscopy offers a safe alternative to other laparoscopic approaches. Despite the higher technical complexity, the duration of surgery is shorter with faster resumption of oral intake. Studies with larger sample size and longer follow-up will be required to confirm the benefits of this approach.

Single-Port Laparoscopic Surgery for Inflammatory Bowel Disease

“…13 studies reported exclusion criteria for SPLS procedures in patients with IBD: these were in particular: body habitus, respectively, BMI > 36 kg/m² [11–13, 23–27], ASA-classification >3 [23], respectively, significant associated comorbidities [24, 25, 28], hemodynamic instability [27], extensive previous abdominal surgery [23–30], previous history of peritonitis [12, 13], emergency surgery such as colonic perforation and toxic megacolon [8, 12, 13, 23, 26, 28, 30], colonic dysplasia or malignancy [11, 26], respectively, low rectal malignancy [30], and pregnancy [29]. …”

“…Two studies reported SPLS colectomy with ileorectal anastomosis [17, 30]. SPLS port insertion was usually accomplished at the previously marked ileostomy site [24, 25, 28, 37]. For SPLS colectomy, most authors commenced dissection at the right hemicolon, arguing this part to be the most difficult and associated with the highest risk for conversion, followed by further clockwise dissection [20, 24–26, 37].…”

“…In the present review of the literature, no specific data on the patient's exposure to immunosuppressive drugs could be retrieved. Some of the selected studies, however, reported preoperative administration of azathioprine, steroids, or biologicals [8, 16, 24, 25, 28, 35, 37], indicating that the application of these drugs does not represent a contraindication for SPLS. In patients undergoing restorative proctocolectomy for medically refractory ulcerative colitis, a three-stage SPLS procedure was advocated when patients received more than 20 mg of prednisolone or anti-TNF- α agents such as infliximab or adalimumab [8].…”

Minimally Invasive Surgery for Inflammatory Bowel Disease

“…The SILS approach has also been used successfully in surgery for CUC. In 2011, Fichera et al 94 reported a series of 10 patients with medically refractory disease who underwent SILS total abdominal colectomy with end ileostomy. Results were comparable with case-matched laparoscopic-assisted and hand-assisted laparoscopy patients with shorter duration of surgery and earlier resumption of a solid diet, although these benefits are questionable based on study design.…”

Laparoscopic approach for inflammatory bowel disease surgical management

“…Furthermore, Seshadri et al suggested that laparoscopic approach might be associated with a lower rate of long-term complications, including incisional hernia and bowel obstruction. More recently, Fichera et al published their experience with total abdominal colectomy for refractory colitis performed through a single incision laparoscopic approach with encouraging results 35 . However, further studies are required to confirm the benefits of this emerging technique 36 .…”