Page 60 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE
Evolution of Surgical Management for Ulcerative Colitis in

the Last Decade: A Comprehensive Literature Review

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Aashna Mehta , Aniket Agrawal , Gursev Sandlas , Vivek Viswanathan 4
Received on: 12 April 2022; Accepted on: 14 September 2022; Published on: 07 December 2022
AbstrAct
Introduction: Inflammatory bowel disease (IBD) is a term that canopies disorders which involve conditions causing chronic inflammation of
the gastrointestinal tract (GIT). It mainly includes two conditions, viz.: Crohn’s disease (Crohn’s) and ulcerative colitis (UC). Ulcerative colitis had
a high mortality rate of >50% until the mid-1950s corticosteroids were first introduced for its treatment. Since then, there have been many
advances in the management of UC, with the current approach being initial treatment with pharmacological therapy and switching over to
surgical management in refractory cases. Our review aimed to look at how the surgical management of UC has advanced over the last decade
in various aspects.
Materials and methods: The authors searched the PubMed database in December 2021 using the search terms “IPAA for UC” and “Total
Proctocolectomy for UC”. After applying the inclusion and exclusion criteria, we found 57 articles that were numbered from 1 to 57 and entered
in a randomizer (https://www.randomizer.org/) that gave us seven random numbers, and articles corresponding to those numbers were
considered for this review.
Conclusion: Surgical management for UC has evolved toward a minimal access approach in the last decade; however, complications such
as pouchitis and anastomotic leak are still some of the challenges faced in surgical management for UC. Further multicenter cohort studies
comparing the rates of complications in different approaches can produce results that may further improve patient outcomes.
Keywords: Ileal pouch-anal anastomosis, Minimal access surgery, Open surgery, Surgical management of ulcerative colitis, Total proctocolectomy,
Ulcerative colitis.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1535

IntroductIon 1 Faculty of Medicine, University of Debrecen, Debrecen, Hajdú-Bihar,
Inflammatory bowel disease is a term that canopies disorders Hungary
which involve conditions causing chronic inflammation of the GIT. 2,4 Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani
It mainly includes two conditions, viz.: Crohn’s disease (Crohn’s) Hospital and Medical Research Institute, Mumbai, Maharashtra, India
and UC. Both these conditions are associated with inflammation 3 Department of Pediatric Surgery, TNMC and BYL Nair Hospital,
of the digestive tract, with two major differences between the Mumbai, Maharashtra, India
two viz.: (1) The depth of the tissue layers involved (Crohn’s Corresponding Author: Aniket Agrawal, Department of Pediatric
involves transmural thickness of the bowel wall; UC involves Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research
only the mucosal and the submucosal layers) and (2) the extent of Institute, Mumbai, Maharashtra, India, Phone: +91 8668862655, e-mail:
the GIT involved (Crohn’s may involve any portion of the GIT from aniketagrawal.24967@gmail.com
the mouth to the anus; UC is restricted to involving any segment How to cite this article: Mehta A, Agrawal A, Sandlas G, et al. Evolution
from the colon distally). of Surgical Management for Ulcerative Colitis in the Last Decade: A
First described in 1859, UC is defined by mucosal Comprehensive Literature Review. World J Lap Surg 2022;15(3):246–248.
inflammation initiating in the rectum and extending proximally Source of support: Nil
to involve the colon in a continuous fashion. The most common Conflict of interest: None
presenting symptom of this condition is bloody diarrhea;
however, the diagnosis is usually a combination of clinical and
histopathological evidence. For almost a century after it was first
described, the condition had a withering prognosis (mortality MAterIAls And Methods
>50%), until the mid-1950s, when corticosteroids were first used The authors searched through the PubMed database in December
to treat UC. Today, with scientific advancements, the treatment 2021 using the search terms “IPAA for UC” and “Total Proctocolectomy
options for UC (and IBD in general) have broadened, where the for UC”. Articles published only in the year 2010 and 2020 were
current trends include initial management with pharmacological considered for this review. There were 112 articles published in 2010
therapies and switching over to surgical management in and 203 articles published in 2020, giving us a total of 315 articles.
refractory cases. After applying the inclusion and exclusion criteria, we were left
The aim of our comprehensive review is to see how the surgical with 57 articles. We numbered these articles from 1 to 57, and we
management of UC has evolved over the last decade (2010–2020) ran these numbers in a randomizer (https://www.randomizer.org/)
compared to the previous decade (2000–2010) in various aspects which gave us a set of 7 random numbers viz.: 25, 20, 18, 30, 7, 23,
such as technique, approach, outcomes, etc. and 39, and articles corresponding to these numbers were used.

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