Surgical treatment of ulcerative colitis

K Kressler

doi:10.1111/j.1463-1318.2001.00229.x

Abstract

Surgical treatment of ulcerative colitis

Highlights

Ulcerative colitis (UC) is an ubiquitously distributed inflammatory bowel disease
The possible surgical strategies can be schematized in three types of intervention: - total proctocolectomy with definitive ileostomy - total colectomy with ileo-rectal anastomosis (IRA) - restorative proctocolectomy with ileal pouch (RP) In 1997 Little and Parks (Little & Parks, 1977) proposed proctocolectomy with definitive ileostomy for the treatment of UC
When a locally invasive cancer with metastasis to regional nodes is diagnosed, total colectomy should be performed and adjuvant therapy should be given before proctectomy and pouch construction; in patients with metastatic disease RP is contraindicated and colectomy with IRA should be preferred

Summary

Introduction

Ulcerative colitis (UC) is an ubiquitously distributed inflammatory bowel disease. Its incidence varies slightly between geographical areas, most likely because of either the different genetic patrimonies of the involved populations or several environmental factors. Giving an alternative to proctococolectomy with definitive ileostomy, option very humiliating for the patient, Parks and Nicholls (Parks & Nicholls, 1978) proposed in 1978 the restorative proctocolectomy (RP), fashioning an ileal reservoir (pouch) that offered patients a radical treatment of the disease and a good anal function, preserving intestinal continuity and the anus in its natural site This intervention, consisting of removal of the entire colon and rectum to the linea dentata, preserving the sphincters, followed by fashioning of a neo-rectum with the last ileal loops and ileo-anal anastomosis, represented a revolution in surgical treatment of UC, rapidly becoming the intervention of choice for UC in selected centres (Pemberton et al, 1987; Williams, 1989; Selvaggi et al, 1996)

Indications to surgery

Surgical options

Patients selection

Complications

Findings

Conclusions