Surgical Management of Ulcerative Colitis
- As laparoscopic surgery becomes increasingly pervasive, both a hand-assisted and straight laparoscopic colectomy and proctectomy with ileal pouch-anal anastomosis (IPAA) have become more common, with outcomes equivalent to or even improved compared with an open approach.
- Since the introduction of infliximab, biologic therapy has become more prevalent in the inflammatory bowel disease patient population. These medications should be held as long as possible prior to an elective operation as they have been associated with increased infectious complications following IPAA.
- Despite biologic therapy, in the setting of an acute flare of ulcerative colitis, 50% of patients treated with intravenous steroids and an induction done of anti–tumor necrosis factor–α will still go on to have a colectomy within the year.
- The relatively recent introduction of enhanced recovery after surgery protocols in our postoperative care has improved postoperative pain scores and decreased the length of hospital stays. These protocols use a multimodality pain management plan that avoids systemic narcotics, minimizes intravenous fluid administration, enforced early ambulation, and early enteral intake on the night of surgery. The expected length of stay following IPAA is now typically 3 days.
- As an increasing number of immunosuppressive drugs are being introduced for the treatment of ulcerative colitis, a three-stage approach to IPAA is being more commonly employed. A three–stage approach is used for patients who require emergency surgery, are in poor medical condition due to their underlying disease, or are significantly immunosuppressed.
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