• Hand-sewn anastomosis
• Ileal pouch-anal anastomosis
• Minimally invasive surgery
• Ulcerative colitis

• Humans
• Colitis, Ulcerative/surgery
• Female
• Male
• Adult
• Middle Aged
• Japan/epidemiology
• Proctocolectomy, Restorative/trends
• Proctocolectomy, Restorative/methods
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Minimally Invasive Surgical Procedures/trends
• Retrospective Studies
• Young Adult
• Treatment Outcome
• Adolescent
• Anastomosis, Surgical/methods
• Propensity Score
• Laparoscopy/trends

• 2020 Japan Society of Laparoscopic Colorectal Surgery

• Humans
• Proctocolectomy, Restorative/methods
• Proctocolectomy, Restorative/adverse effects
• Colonic Pouches/adverse effects
• Laparoscopy/methods
• Colitis, Ulcerative/surgery
• Anastomosis, Surgical/methods
• Anastomosis, Surgical/adverse effects
• Crohn Disease/surgery
• Minimally Invasive Surgical Procedures/methods

• IPAA
• acute severe ulcerative colitis
• colorectal surgery
• functional outcomes
• medical management
• salvage therapy
• transanal approach
• ulcerative colitis

• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/therapy
• Humans
• Gastroenterology/standards
• Practice Guidelines as Topic
• Germany

• Crohn’s disease
• Inflammatory bowel disease
• Infliximab.
• Peri-operative infections
• Ulcerative colitis

• Blood loss
• Bowel function recovery
• Laparoscopic surgery
• Second colorectal surgery
• Surgical outcomes

• Humans
• Retrospective Studies
• Treatment Outcome
• Colectomy
• Laparoscopy
• Proctectomy
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/pathology

• 20K21626 Japan Society for the Promotion of Science
• 21H02778 Japan Society for the Promotion of Science

• Humans
• Colitis, Ulcerative

• familial adenomatous polyposis
• laparoscopic total proctocolectomy
• protein-losing enteropathy

• Familial adenomatous polyposis
• Ileal pouch-anal anastomosis
• Laparoscopic surgery
• Proctectomy
• Staged operations
• Ulcerative colitis

• colectomy
• ileal pouch–anal anastomosis
• robotic surgery
• ulcerative colitis

• defecation function
• ileal pouch anal anastomosis
• ulcerative colitis restorative proctocolectomy

Colectomy with transanal ileal pouch-anal anastomosis (taIPAA) is a surgical technique that can be used to treat benign colorectal disease. Ulcerative colitis is the most frequent inflammatory bowel disease (IBD) and although pharmacological therapy has improved, colectomy rates reach up to 15%. The objective of this study was to determine anastomotic leakage rates and treatment after taIPAA as well as short- and long-term pouch function.

We conducted a retrospective analysis of a prospective database of all patients undergoing taIPAA at an academic tertiary referral center in Germany, between 01/03/2015 and 31/08/2019. Patients with indications other than ulcerative colitis or with adjuvant chemotherapy following colectomy for colorectal carcinoma were excluded for short- and long-term follow up due to diverging postoperative care yet considered for evaluation of anastomotic leakage.

A total of 22 patients undergoing taIPAA during the study time-window were included in analysis. Median age at the time of surgery was 32 ± 12.5 (14–54) years. Two patients developed an anastomotic leakage at 11 days (early anastomotic leakage) and 9 months (late anastomotic leakage) after surgery, respectively. In both patients, pouches could be preserved with a multimodal approach. Twenty patients out of 22 met the inclusion criteria for short and long term follow-up. Data on short-term pouch function could be obtained in 14 patients and showed satisfactory pouch function with only four patients reporting intermittent incontinence at a median stool frequency of 9–10 times per day. In the long-term we observed an inflammation or “pouchitis” in 11 patients and a pouch failure in one patient.

Postoperative complication rates in patients with benign colorectal disease remain an area of concern for surgical patient safety. In this pilot study on 22 selected patients, taIPAA was associated with two patients developing anastomotic leakage. Future large-scale validation studies are required to determine the safety and feasibility of taIPAA in patients with ulcerative colitis.

• Anastomotic leakage
• Pouchitis
• Transanal ileal pouch-anal anastomosis
• Ulcerative colitis

• Colitis, Ulcerative
• Humans
• Practice Guidelines as Topic

• Emergency
• Robotic surgery
• Subtotal colectomy
• Ulcerative colitis

• Ambulatory Care/methods
• Colectomy/methods
• Colitis, Ulcerative/surgery
• Female
• Humans
• Laparoscopy/methods
• Male
• Robotic Surgical Procedures/methods
• Severity of Illness Index
• Treatment Outcome

Inflammatory bowel disease (IBD) in Korea has been increasing in recent years, but accurate statistics about operations for IBD are lacking. The purpose of this study was to investigate the trends and current status of IBD surgeries in Korea.

Using a national database from the Korea Health Insurance Review and Assessment Service, we analyzed data from patients who underwent surgery for Crohn disease and ulcerative colitis from January 2009 to October 2016.

The mean number of patients who underwent surgery for Crohn disease was 791.8 per year. Colorectal surgery, small bowel surgery, and anal surgery were performed fairly often (31.2%, 29.4%, 39.4%, respectively), and laparoscopic surgery continued to increase, recently exceeding 30%. About 50% of Crohn patients used biologics before and after surgery, and those patients also underwent a relatively high rate of anal surgeries (44.2%). The mean number of patients who underwent surgery for ulcerative colitis was 247.6 per year. Colorectal surgery accounted for more than half of all operations, and laparoscopic surgery has been increasing rapidly, having been performed in about 60% of patients in recent years. The incidence of colorectal cancer in patients with ulcerative colitis was very high and increased rapidly during the study period, reaching about 80%.

The number of patients undergoing laparoscopic surgery for IBD in Korea has increased significantly. Biologics are actively used by patients with Crohn disease, with a high proportion of anal surgeries required. Many of the surgical indications for ulcerative colitis have shifted into colorectal cancer.

• Colitis-associated cancer
• Crohn disease
• Inflammatory bowel disease
• Laparoscopy
• Ulcerative colitis

• Colorectal resection
• Inflammatory bowel disease
• Robotic surgical procedures

外科治疗是溃疡性结肠炎(ulcerative colitis, UC)的重要组成部分, 全结直肠切除、回肠贮袋肛管吻合术(ileal pouch-anal anastomosis, IPAA)已成为标准术式. 近年来在微创外科技术的迅猛发展与普及下, 越来越多医疗中心开展腹腔镜IPAA手术. 腹腔镜IPAA手术相比于开腹手术的在术后近、远期疗效中的优势逐渐突显, 且其安全有效性已达成共识. 目前更多更为微创的技术也陆续尝试应用于IPAA手术. 但是由于UC患者自身疾病的特点和IPAA术式的复杂性, 腹腔镜IPAA手术仍未达到标准化、规范化水平. 本文主要针对UC微创外科术后疗效和合理应用的研究进展作一述评.

• 溃疡性结肠炎
• 回肠贮袋
• 吻合手术
• 腹腔镜
• 微创手术

• Follow-up
• Functional outcomes
• Ileal pouch-anal anastomosis (IPAA)
• Laparoscopy
• Long-term

• Laparoscopic surgery
• SILS
• ulcerative colitis

• Affordable Care Act
• Anesthetic approaches
• ERAS
• Protocol-driven care
• Value-based care

• Humans
• Length of Stay/statistics & numerical data
• Outcome Assessment, Health Care/methods
• Patient Protection and Affordable Care Act
• Perioperative Care/methods
• Postoperative Complications/prevention & control

• Age Factors
• Colectomy/methods
• Colonic Neoplasms/complications
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Humans
• Laparoscopy
• Neoplasm Staging
• Treatment Outcome

• Functional outcome
• ileal pouch
• ileal pouch-anal anastomosis
• laparoscopic total proctocolectomy
• ulcerative colitis

• IBD
• gastroenterology
• surgery

• ileal pouch-anal anastomosis
• laparoscopy
• proctocolectomy
• ulcerative colitis

• Colorectal cancer
• Colorectal disease
• Emergency surgery
• Inflammatory bowel disease
• Laparoscopic surgery

• Colectomy/adverse effects
• Colectomy/methods
• Colonic Diseases/diagnosis
• Colonic Diseases/surgery
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/surgery
• Emergencies
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Patient Selection
• Postoperative Complications/etiology
• Rectal Diseases/diagnosis
• Rectal Diseases/surgery
• Risk Factors
• Treatment Outcome

• Anal Canal/surgery
• Anastomosis, Surgical
• Colitis, Ulcerative/surgery
• Colonic Pouches
• Female
• Humans
• Laparoscopy/instrumentation
• Laparoscopy/methods
• Laparoscopy/trends
• Length of Stay
• Male
• Proctocolectomy, Restorative/instrumentation
• Proctocolectomy, Restorative/methods
• Proctocolectomy, Restorative/trends
• Robotic Surgical Procedures/trends
• Treatment Outcome

Background. The incidence of inflammatory bowel disease (IBD) is increasing in the paediatric population. Since 2007, a single surgeon whose main practice is in the treatment of adults has performed surgery for IBD in adults and children within two dedicated multidisciplinary teams. Our aim was to assess and compare outcomes for adults and children following surgery for IBD. Methods. Analysis of a prospectively collected database was carried out to include all patients who had undergone resectional surgery for IBD between 2007 and 2012. Results. 48 adults and 30 children were included in the study. Median age for children was 14 years (range 8–16) and for adults was 33.5 years (range 17–64). Median BMI was 23 (range 18–38) and 19 (range 13–29.5) in adults and children, respectively (P < 0.001). Laparoscopic resection was performed in 27 (90%) children and 36 (75%) adults. Postoperative complication rates were comparable, 11 (23%) in adults versus 6 (20%) in children (P = 1.00). Conclusion. Resectional surgery for IBD in children has outcomes that compare favourably with the adult population, with the majority of cases being performed by a laparoscopic approach.

• Inflammatory bowel disease
• laparoscopy
• ulcerative colitis

• Elective Surgical Procedures/methods
• Elective Surgical Procedures/rehabilitation
• Humans
• Intraoperative Complications/prevention & control
• Laparoscopy/rehabilitation
• Medical Audit
• Outcome and Process Assessment, Health Care
• Pelvis/surgery
• Perioperative Care/methods
• Perioperative Care/standards
• Postoperative Complications/prevention & control
• Recovery of Function
• Rectum/surgery

Despite significant improvements in medical management of inflammatory bowel disease, many of these patients still require surgery at some point in the course of their disease. Their young age and poor general conditions, worsened by the aggressive medical treatments, make minimally invasive approaches particularly enticing to this patient population. However, the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting, currently mostly pursued in high-volume referral centers, despite accumulating evidences in the literature supporting the benefits of minimally invasive surgery. The largest body of evidence currently available for terminal ileal Crohn’s disease shows improved short term outcomes after laparoscopic surgery, with prolonged operative times. For Crohn’s colitis, high quality evidence supporting laparoscopic surgery is lacking. Encouraging preliminary results have been obtained with the adoption of laparoscopic restorative total proctocolectomy for the treatment of ulcerative colitis. A consensus about patients’ selection and the need for staging has not been reached yet. Despite the lack of conclusive evidence, a wave of enthusiasm is pushing towards less invasive strategies, to further minimize surgical trauma, with single incision laparoscopic surgery being the most realistic future development.

• Laparoscopic surgery
• Inflammatory bowel disease
• Ulcerative colitis
• Crohn’s disease

• Child
• Clinical Protocols
• Colitis, Ulcerative/therapy
• Consensus
• Europe
• Humans
• Pediatrics
• Societies, Medical

• G0800675 Medical Research Council
• G1002033 Medical Research Council

Despite the growing use of medical salvage therapy, colectomy has remained a cornerstone in managing acute severe ulcerative colitis (ASC) both in children and in adults. Colectomy should be regarded as a life saving procedure in ASC, and must be seriously considered in any steroid-refractory patient. However, colectomy is not a cure for the disease but rather the substitution of a large problem with smaller problems, including fecal incontinence, pouchitis, irritable pouch syndrome, cuffitis, anastomotic ulcer and stenosis, missed or de-novo Crohn’s disease and, in young females, reduced fecundity. This notion has led to the widespread practice of offering medical salvage therapy before colectomy in most patients without surgical abdomen or toxic megacolon. Medical salvage therapies which have proved effective in the clinical trial setting include cyclosporine, tacrolimus and infliximab, which seem equally effective in the short term. Validated predictive rules can identify a subset of patients who will eventually fail corticosteroid therapy after only 3-5 d of steroid therapy with an accuracy of 85%-95%. This accuracy is sufficiently high for initiating medical therapy, but usually not colectomy, early in the admission without delaying colectomy if required. This approach has reduced the colectomy rate in ASC from 30%-70% in the past to 10%-20% nowadays, and the mortality rate from over 70% in the 1930s to about 1%. In general, restorative proctocolectomy (ileoanal pouch or ileal pouch-anal anastomosis), especially the J-pouch, is preferred over straight pull-through (ileo-anal) or ileo-rectal anastomosis, which may still be considered in young females concerned about infertility. Colectomy in the acute severe colitis setting, is usually performed in three steps due to the severity of the inflammation, concurrent steroid treatment and the generally reduced clinical condition. The first surgical step involves colectomy and constructing an ileal stoma, the second - constructing the pouch and the third - closing the stoma. This review focuses on the role of surgical treatment in ulcerative colitis in the era of medical rescue therapy.

• Acute severe ulcerative colitis
• Colectomy
• Corticosteroids
• Cyclosporine
• Infliximab
• Tacrolimus

Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis, biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease. The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven. Furthermore, these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications. Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients. Surgery is traditionally recommended as salvage therapy when medical management fails, and, despite advances in medical therapy, colectomy rates remain unchanged between 20% and 30%. To overcome the reported increase in postoperative complications in patients on biologic therapies, several surgical strategies have been developed to maintain long-term pouch failure rate around 10%, as previously reported. Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.

• Ulcerative colitis
• Inflammatory bowel disease
• Infliximab
• Surgery
• Laparoscopy
• Single incision laparoscopy
• Total abdominal colectomy
• Ileal pouch anal anastomosis
• Restorative proctocolectomy