Surgery for inflammatory bowel disease in the era of laparoscopy

Abstract

During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn’s disease (CD) patients will undergo an operation during their lifetime. For UC patients requiring surgery, total proctocolectomy and ileoanal pouch anastomosis (IPAA) is the operation of choice as it provides a permanent cure and good quality of life. Nevertheless a permanent stoma is a good option in selected patients, especially the elderly. Minimally invasive surgery has replaced the conventional open approach in many specialized centres worldwide. Laparoscopic colectomy and restorative IPAA is rapidly becoming the standard of care in the treatment of UC requiring surgery, whilst laparoscopic ileo-cecal resection is already the new gold standard in the treatment of complicated CD of terminal ileum. Short term advantages of laparoscopic surgery includes faster recovery time and reduced requirement for analgesics. It is, however, in the long term that minimally invasive surgery has demonstrated its superiority over the open approach. A better cosmesis, a reduced number of incisional hernias and fewer adhesions are the long term advantages of laparoscopy in IBD surgery. A reduction in abdominal adhesions is of great benefit when a second operation is needed in CD and this influences positively the pregnancy rate in young women undergoing restorative IPAA. In developing the therapeutic plan for IBD patients it should be recognized that the surgical approach to the abdomen has changed and that surgical treatment of complicated IBD can be safely performed with a true minimally invasive approach with great patient satisfaction.

Keywords: Laparoscopy; Ulcerative colitis; Surgery; Inflammatory bowel disease; Laparoscopic surgery; Proctocolectomy; Ileoanal pouch anastomosis

Core tip: The clinical management of inflammatory bowel disease (IBD) patients has dramatically changed in the last decades and primary, secondary and even tertiary levels of medical treatment are available to treat both Crohn’s disease or ulcerative colitis. However, it should be recognized that surgical approaches have also changed, for the better, in the last few years and that minimally invasive surgery is now available in most centers. The timing of surgery is a key issue for proper management of IBD patients. Laparoscopic surgery should be seen as less aggressive than the standard surgical approach and could lower the threshold for surgical intervention.