Kryvoruk M. Laparoscopic technologies for Ulcerative Colitis surgical treatment

The efficacy of applying the laparoscopic technique for ulcerative colitis surgical treatment is still being discussed. The aim of this study was to improve the short- and long-term postoperative outcomes of ulcerative colitis patients' surgical treatment based on the innovated surgical strategy with application of laparoscopic technologies. The results of 173 Ulcerative Colitis surgical treatment cases are presented. 69 patients were operated during 1989-1998 (control group). 104 patients were operated during 1999-2010 (study group). A total of 33 patients of study group underwent laparoscopic surgery. Laparoscopic-assisted primary restorative proctocolectomy with ileal pouch-anal anastomosis was done in 8 patients. Laparoscopic conservative colectomy (total colectomy combined with obstructed low anterior resection of rectum and terminal ileostomy) was performed in 25 patients. Laparoscopic second-stage restorative ileal pouch-anal anastomosing procedure was done in 7 patients. Open primary restorative proctocolectomy with ileal pouch-anal anastomosis was performed in 12 patients. Open conservative colectomy - in 59 patients. Open second-stage restorative surgery was done in 13 patients. Laparoscopic proctocolectomy appeared to be technically feasible both for primary and for two-staged restorative proctocolectomy. Primary laparoscopic approach facilitated the second stage restorative procedure thanks to a small number of adhesions and free access to the pelvis. Functional results depended on anal sphincter preservation status, ileal pouch capacity. Neither pouch design nor the type of pouch-anal anastomosis (double stapling or hand-sewn) did greatly influence functional outcome. Laparoscopic colectomy compared with the open surgery is beneficial to the patient in terms of less scaring, less postoperative pain, shorter hospital stay, quicker return to oral feeding, and quicker return to physical activities.