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Evolution of Surgical Management for Ulcerative Colitis
            number of surgeries being performed for acute indications,   references
            lower albumin levels before colectomy, and more patients with
                                                            9
            the extensive disease which is a known risk factor for pouchitis.      1.  Kobayashi T, Siegmund B, Le Berre C, et al. Ulcerative colitis (Primer).
                                                                    Nat Rev Dis Primers. 2020;6(1):74. DOI: 10.1038/s41572-020-0205-x.
            Limitations of the study are its unicenter, retrospective design, and a     2.  Ullman T, Odze R, Farraye FA. Diagnosis and management of dysplasia
            small sample size of 212 patients relative to the duration of the study   in patients with ulcerative colitis and Crohn’s disease of the colon.
                   9
            (26 years).  Over the last decade, minimal access IPAA has evolved   Inflamm Bowel Dis 2009;15(4):630–638. DOI: 10.1002/ibd.20766.
            from a laparoscopic approach giving way to newer techniques     3.  Ng KS, Gonsalves SJ, Sagar PM. Ileal-anal pouches: A review of
            like single incision laparoscopy surgery (SILS), natural orifice   its history, indications, and complications. World J Gastroenterol
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            transluminal endoscopic surgery (NOTES), and robotic surgery.    2019;25(31):4320–4342. DOI: 10.3748/wjg.v25.i31.4320.
            However, there is scope for further improvement, especially in     4.  Kirat HT, Remzi FH. Technical aspects of ileoanal pouch surgery in
            terms of minimizing complications and improving educational   patients with ulcerative colitis. Clin Colon Rectal Surg 2010;23(4):
                                                                    239–247. DOI: 10.1055/s-0030-1268250.
            training, access, and feasibility of minimally invasive techniques     5.  Ikeuchi H, Uchino M, Matsuoka H, et al. Surgery for ulcerative colitis in
            for treating UC. Complications from IPAA such as pouch failure,   1,000 patients. Int J Colorectal Dis 2010;25(8):959–965. DOI: 10.1007/
            small intestinal obstruction, and Crohn’s disease of pouch still are   s00384-010-0915-8.
            some of the challenges in care provision for UC. 3,12  Perhaps, further     6.  McKevitt K, Ryan PC, Sahebally SM, et al. Twenty years of restorative
            cohort studies comparing outcomes between the open and the   proctocolectomy with ileal pouch anal anastomosis in Beaumont
            minimal access approach could help delineate finer differences   Hospital. Ir J Med Sci 2021;190(1):275–280. DOI: 10.1007/s11845-020-
            between the two approaches which were not previously seen due   02297-1
            to paucity of data.                                  7.  Fajardo AD, Dharmarajan S, George V, et al. Laparoscopic versus
                                                                    open 2-stage ileal pouch: Laparoscopic approach allows for faster
                                                                    restoration of intestinal continuity. J Am Coll Surg 2010;211(3):377–
            conclusIon                                              383. DOI: 10.1016/j.jamcollsurg.2010.05.018.
                                                                 8.  Hota S, Parascandola S, Amdur R, et al. Evaluation of minimally invasive
            Restorative proctocolectomy with ileal pouch-anal anastomosis has   surgical therapies for ulcerative colitis. Am Surg 2020;86(7):782–786.
            emerged as the gold standard procedure for surgical management   DOI: 10.1177/0003134820934417.
            of UC. In our review, we observed the evolution of the surgical     9.  Lim MH, Lord AR, Simms LA, et al. Ileal pouch-anal anastomosis
            approach from open to minimally access surgery in the last   for ulcerative colitis: An Australian institution’s experience. Ann
            decade. It has also paved the way for recent advances such as   Coloproctol 2021;37(5):318–325. DOI: 10.3393/ac.2020.08.26.
            SILS, NOTES, and robotic surgery which have shown immense     10.  Germain A, de Buck van Overstraeten A, Wolthuis A, et al. Outcome
            potential. Although minimal access surgery is associated with better   of restorative proctocolectomy with an ileo-anal pouch for
            postoperative outcomes, especially in terms of return to function   ulcerative colitis: Effect of changes in clinical practice. Colorectal Dis
            and cosmesis, it also requires longer operating times and specialized   2018;20(2):O30–O38. DOI: 10.1111/codi.13948.
            training. Complications such as pouchitis, anastomotic leak, and     11.  Nagpal AP, Soni H, Haribhakti S. Hybrid single-incision laparoscopic
                                                                    restorative proctocolectomy with ileal pouch anal anastomosis for
            small intestinal obstruction are still some of the challenges faced   ulcerative colitis. Indian J Surg 2010;72(5):400–403. DOI: 10.1007/
            in surgical treatment for UC. Further, multicenter cohort studies   s12262-010-0125-1.
            comparing the rates of complications in different approaches can     12.  Lightner AL, Pemberton JH, Loftus Jr EJ. Crohn’s disease of the ileoanal
            help delineate finer differences that may help improve the overall   pouch. Inflamm Bowel Dis 2016;22(6):1502–1508. DOI: 10.1097/
            quality of life in UC patients as we move on to the next decade.  MIB.0000000000000712.

            orcId
            Aashna Mehta   https://orcid.org/0000-0003-2226-0906
            Aniket Agrawal   https://orcid.org/0000-0002-2660-5118
            Gursev Sandlas   https://orcid.org/0000-0003-4890-9080
            Vivek Viswanathan   https://orcid.org/0000-0001-8488-0145


























            248   World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022)
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