Surgical management of IBD—from an open to a laparoscopic approach

Abstract

Surgery is a key feature of IBD management. Up to 70% of patients with Crohn's disease and 35% of patients with ulcerative colitis will require surgery during the course of their disease. This Review provides an overview of IBD surgical management, focusing on the potential benefits and drawbacks of laparoscopy compared with open surgery. Emergency and elective indications for both laparoscopic and open surgery are detailed for patients with ulcerative colitis and Crohn's disease. Evidence-based comparative results of these surgical approaches are discussed, along with factors that influence patient outcomes. Upcoming new techniques for IBD surgical management, including single-port surgery, are also presented.

Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives

“…Studies investigating the best population that would benefit most by laparoscopic approaches are still missing. However today, in specialized centers primary resections such as ileocecal resection for Crohn' s disease or restorative proctocolectomy for ulcerative colitis are almost routinely performed at least with laparoscopic assistance [5] .…”

“…On the down part laparoscopic surgery is associated with longer operative times. Taken together laparoscopy seems to be safe for cases of medical refractory severe colitis; however no study has yet shown feasibility of laparoscopic approaches for complications such as perforation or toxic megacolon [5] . Therefore "emergency surgery" should be interpreted as "urgent surgery" for refractory disease in studies as mentioned above, while critical bleeding or free perforations with four quadrant peritonitis still seem to be a domain of conventional surgery in ulcerative colitis.…”

“…Therefore development of surgical techniques to minimize opera tive trauma has been of great interest. In fact minimally invasive surgery has been one of the recent major advances in surgery in the last decades [5] .…”

The present status and developments of laparoscopic surgery for colorectal cancer

“…In Japan, the first such surgery was performed in 1992 for a patient with cecal cancer 2) . Subsequently, the indications for laparoscopic surgery were gradually expanded to include colorectal cancer and inflammatory bowel diseases such as appendicitis and diverticulitis 3) . Around 1994, however, frequent port site recurrences following laparoscopic surgery for colon cancer were reported, resulting in laparoscopic surgery temporarily being considered contraindicated 4) .…”

Present laparoscopic surgery for colorectal cancer in Japan

“…Present laparoscopic surgery for colorectal cancer in Japan first such surgery was performed in 1992 for a patient with cecal cancer [2] . Subsequently, the indications for LS were gradually expanded to include colorectal cancer and inflammatory bowel diseases such as appendicitis and diverticulitis [3] . Around 1994, however, frequent port site recurrences (PSR) after LS for colon cancer were reported, resulting in LS temporarily being deemed to be contraindicated [4] .…”