Gastroenterologie
a hepatologie

Possibilities of minimally invasive surgery in patients with Crohn’s disease and ulcerative colitis

Lumír Kunovský^1,2, Filip Marek¹, Zdeněk Kala ^{Orcid.org  1}, Jiří Dolina ^{Orcid.org  3}, Petr Moravčík⁴, Vladimír Čan¹, Vladimír Procházka ^{Orcid.org  1}

+ Affiliation
¹ Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
² Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
³ Interní gastroenterologická klinika LF MU a FN Brno
⁴ Faculty of Medicine, Masaryk University, Brno, Department of Surgery, University Hospital Brno, Czech Republic

Summary

Crohn’s disease and ulcerative colitis are considered as chronic inflammatory bowel diseases where, even with the possibility of biological therapy, surgery still has an irreplaceable role in the treatment. This article briefly summarizes the indications for surgery in patients with inflammatory bowel diseases. Discussed are the possibilities of minimally invasive surgery from laparoscopic-assisted procedures to brand new minimally invasive techniques. The text mentions our experience – the advantages and disadvantages of the new surgical techniques with the references to the latest studies and literature reviews. The article also discusses the influence of surgical treatment on the quality of life of patients with inflammatory bowel disease.

Keywords

Crohn’s disease, surgery, inflammatory bowel disease, quality of life, laparoscopy, ulcerative colitis

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Literature

1. Molodecky NA, Soon IS, Rabi DM et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012; 142 (1): 46–54. doi: 10.1053/j.gastro.2011.10.001.
2. Wilson J, Hair C, Knight R et al. High incidence of inflammatory bowel disease in Australia: a prospective population-based Australian incidence study. Inflamm Bowel Dis 2010; 16 (9): 1550–1556. doi: 10.1002/ ibd.21209.
3. Nørgård BM, Nielsen J, Fonager K et al. The incidence of ulcerative colitis (1995–2011) and Crohn’s disease (1995–2012) – based on nationwide Danish registry data. J Crohns Colitis 2014; 8 (10): 1274–1280. doi: 10.1016/j.crohns.2014.03.006.
4. Vegh Z, Burisch J, Pedersen N et al. Incidence and initial disease course of inflammatory bowel diseases in 2011 in Europe and Australia: Results of the 2011 ECCO-EpiCom inception cohort. J Crohns Colitis 2014; 8 (11): 1506–1515. doi: 10.1016/j.crohns.2014.06.004.
5. Kunovský L, Hemmelová B, Kala Z et al. Crohn disease and pregnancy: a case report of an acute abdomen. Int J Colorectal Dis 2016; 31 (8): 1493–1494. doi: 10.1007/s00384-016-2554-1.
6. Pedersen N, Bortoli A, Duricova D et al. The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom Study of 209 pregnant women. Aliment Pharmacol Ther 2013; 38 (5): 501–512. doi: 10.1111/apt.12412.
7. Julsgaard M, Nørgaard M, Hvas CL et al. Influence of medical treatment, smoking and disease activity on pregnancy outcomes in Crohn’s disease. Scand J Gastroenterol 2014; 49 (3): 302–308. doi: 10.3109/ 00365521.2013.879200.
8. Aratari A, Papi C, Leandro G et al. Early versus late surgery for ileo-caecal Crohn’s disease. Aliment Pharmacol Ther 2007; 26 (10): 1303–1312.
9. De Cruz P, Kamm MA, Hamilton AL et al. Crohn’s disease management after intestinal resection: a randomised trial. The Lancet 2015; 385 (9976): 1406–1417. doi: 10.1016/S0140-6736 (14) 61908-5.
10. Fornaro R, Caratto E, Caratto M et al. Post-operative recurrence in Crohn’s disease. Critical analysis of potential risk factors. An update. The Surgeon 2015; 13 (6): 330–347. doi: 10.1016/j.surge.2015.04. 002.
11. Targownik LE, Singh H, Nugent Z et al. The epidemiology of colectomy in ulcerative colitis: results from a population-based cohort. Am J Gastroenterol 2012; 107 (8): 1228–1235. doi: 10.1038/ajg.2012.127.
12. Bernstein CN, Ng SC, Lakatos PL et al. A review of mortality and surgery in ulcerative colitis: milestones of the seriousness of the disease. Inflamm Bowel Dis 2013; 19 (9): 2001–2010. doi: 10.1097/MIB. 0b013e318281f3bb.
13. Cosnes J, Gower-Rousseau C, Seksik P et al. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 2011; 140 (6): 1785–1794. doi: 10.1053/j.gastro.2011.01.055.
14. Filippi J, Allen PB, Hébuterne X et al. Does anti-TNF therapy reduce the requirement for surgery in ulcerative colitis? A systematic review. Curr Drug Targets 2011; 12 (10): 1440–1447.
15. Buskens CJ, Sahami S, Tanis PJ et al. The potential benefits and disadvantages of laparoscopic surgery for ulcerative colitis: a review of current evidence. Best Pract Res Clin Gastroenterol 2014; 28 (1): 19–27. doi: 10.1016/j.bpg.2013.11.007.
16. Ikeuchi H, Yamamura T. Free perforation in Crohn’s disease: review of the Japanese literature. J Gastroenterol 2002; 37 (12): 1020–1027.
17. Veroux M, Angriman I, Ruffolo C et al. A rare surgical complication of Crohn’s diseases: free peritoneal perforation. Minerva Chir 2003; 58 (3): 351–354.
18. Pardi DS, Loftus EV, Tremaine WJ et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc 1999; 49 (2): 153–157.
19. Veroux M, Angriman I, Ruffolo C et al. Severe gastrointestinal bleeding in Crohn’s disease. Ann Ital Chir 2003; 74 (2): 213–215.
20. Kostka R, Lukáš M. Massive, life-threatening bleeding in Crohn’s disease. Acta Chir Belg 2005; 105 (2): 168–174.
21. Hyman NH, Cataldo P, Osler T. Urgent subtotal colectomy for severe inflammatory bowel disease. Dis Colon Rectum 2005; 48 (1): 70–73.
22. Stewart D, Chao A, Kodner I et al. Subtotal colectomy for toxic and fulminant colitis in the era of immunosuppressive therapy. Colorectal Dis 2009; 11 (2): 184–190. doi: 10.1111/j.1463-1318.2008.01579.x.
23. Šerclová Z, Ryska O, Bortlík M et al. Doporučené postupy chirurgické léčby pacientů s idiopatickými střevními záněty – 2. část: Crohnova nemoc. Gastroenterol Hepatol 2015; 69 (3): 223–238. doi: 10.14735/amgh2015223.
24. Lazarev M, Ullman T, Schraut WH et al. Small bowel resection rates in Crohn’s disease and the indication for surgery over time: experience from a large tertiary care center. Inflamm Bowel Dis 2010; 16 (5): 830–835. doi: 10.1002/ibd.21118.
25. Poritz LS, Gagliano GA, McLeod RS et al. Surgical management of entero and colocutaneous fistulae in Crohn’s disease: 17 year’s experience. Int J Colorectal Dis 2004; 19 (5): 481–485.
26. Tichansky D, Cagir B, Yoo E et al. Strictureplasty for Crohn’s disease: meta-analysis. Dis Colon Rectum 2000; 43 (7): 911–919.
27. Yamamoto T, Fazio VW, Tekkis PP.  Safety and efficacy of strictureplasty for Crohn’s disease: a systematic review and meta-analysis. Dis Colon Rectum 2007; 50 (11): 1968–1986.
28. Kala Z, Marek F, Válek V el al. Crohn’s disease surgery. Vnitr Lek 2014; 60 (7–8): 617–623.
29. Gionchetti P, Dignass A, Danese S et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: Surgical management and special situations. J Crohns Colitis 2016; 11 (2): 135–149.
30. Feagins LA, Holubar SD, Kane SV et al. Current strategies in the management of intra-abdominal abscesses in Crohn’s disease. Clin Gastroenterol Hepatol 2011; 9 (10): 842–850. doi: 10.1016/j.cgh.2011.04.023.
31. Xie Y, Zhu W, Li N et al. The outcome of initial percutaneous drainage versus surgical drainage for intra-abdominal abscesses in Crohn’s disease. Int J Colorectal Dis 2012; 27 (2): 199–206. doi: 10.1007/s00384-011-1338-x.
32. de Groof EJ, Carbonnel F, Buskens CJ et al. Abdominal abscess in Crohn’s dis-ease: multidisciplinary management. Dig Dis 2014; 32 (Suppl 1): 103–109. doi: 10. 1159/000367859.
33. Šerclová Z, Ryska O, Bortlík M et al. Doporučené postupy chirurgické léčby pacientů s idiopatickými střevními záněty – 3. část: ulcerózní kolitida, indikace k operaci. Gastroenterol Hepatol 2016; 70 (3): 252–261. doi: 10.14735/amgh2015252.
34. Dignass A, Lindsay JO, Sturm A et al. Second european evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis 2012; 6 (10): 991–1030. doi: 10.1016/j.crohns.2012.09.002.
35. Gan SI, Beck PL. A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am J Gastroenterol 2003; 98 (11): 2363–2371.
36. Berg DF, Bahadursingh AM, Kaminski DL et al. Acute surgical emergencies in inflammatory bowel disease. Am J Surg 2002; 184 (1): 45–51.
37. Ross H, Steele SR, Varma M et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum 2014; 57 (1): 5–22. doi: 10.1097/DCR.0000000000000030.
38. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48 (4): 526–535.
39. Tilney HS, Constantinides VA, Heriot AG et al. Comparison of laparoscopic and open ileocecal resection for Crohn’s disease: a metaanalysis. Surg Endosc 2006; 20 (7): 1036–1044.
40. Maartense S, Dunker MS, Slors JF et al. Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease. Ann Surg 2006; 243 (2): 143–149.
41. Lesperance K, Martin MJ, Lehmann R et al. National trends and outcomes for the surgical therapy of ileocolonic Crohn’s disease: a population-based analysis of laparoscopic vs. open approaches. J Gastro-intest Surg 2009; 13 (7): 1251–1259. doi: 10.1007/s11605-009-0853-3.
42. Makni A, Chebbi F, Ksantini R et al. Laparoscopic-assisted versus conventional ileocolectomy for primary Crohn’s disease: results of a comparative study. J Visc Surg 2013; 150 (2): 137–143. doi: 10.1016/j.jviscsurg.2012.10.006.
43. Shore G, Gonzalez QH, Bondora A et al. Laparoscopic vs conventional ileocolectomy for primary Crohn disease. Arch Surg 2003; 138 (1): 76–79.
44. Duepree H-J, Senagore AJ, Delaney CP et al. Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 2003; 197 (2): 177–181.
45. Antoniou SA, Antoniou GA, Koch OO et al. Is laparoscopic ileocecal resection a safe option for Crohn’s disease? Best evidence topic. Int J Surg 2014; 12 (1): 22–25. doi: 10.1016/j.ijsu.2013.11.003.
46. Lee Y, Fleming FJ, Deeb AP et al. A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn’s disease: an analysis of outcomes from the NSQIP database. Colorectal Dis 2012; 14 (5): 572–577. doi: 10.1111/j.1463-1318.2011.02756.x.
47. Maggiori L, Panis Y. Laparoscopy in Crohn’s disease. Best Pract Res Clin Gastroenterol 2014; 28 (1): 183–194. doi: 10.1016/ j.bpg.2013.11.004.
48. Örhalmi J, Dušek T, Šerclová Z et al. Minimally invasive surgery in the treatment of inflammatory bowel disease – benefits, risks and perspectives. Gastroenterol Hepatol 2016; 70 (1): 57–60. doi: 10.14735/amgh201657.
49. Tavernier M, Lebreton G, Alves A. Laparoscopic surgery for complex Crohn’s disease. J Visc Surg 2013; 150 (6): 389–393. doi: 10.1016/j.jviscsurg.2013.09.004.
50. Lim JY, Kim J, Nguyen SQ. Laparoscopic surgery in the management of Crohn’s disease. World J Gastrointest Pathophysiol 2014; 5 (3): 200–204. doi: 10.4291/wjgp.v5.i3.200.
51. Sauerland S, Agresta F, Bergamaschi R et al. Laparoscopy for abdominal emergencies. Surg Endosc Interv Tech 2006; 20 (1): 14–29.
52. Agresta F, Ciardo LF, Mazzarolo G et al. Peritonitis: laparoscopic approach. World J Emerg Surg 2006; 1: 9.
53. Tan JJ, Tjandra JJ. Laparoscopic surgery for Crohn’s disease: a meta-analysis. Dis Colon Rectum 2007; 50 (5): 576–585.
54. Parray FQ, Wani ML, Bijli AH et al. Crohn’s disease: a surgeon’s perspective. Saudi J Gastroenterol 2011; 17 (1): 6–15. doi: 10.4103/1319-3767.74430.
55. Procházka V, Zetelová A, Grolich T et al. Kompletní mezokolická excize u pravostranné hemikolektomie. Rozhl Chir 2016; 95 (10): 359–364.
56. Gardenbroek TJ, Verlaan T, Tanis PJ et al. Single-port versus multiport laparoscopic ileocecal resection for Crohn’s disease. J Crohns Colitis 2013; 7 (10): 443–448. doi: 10.1016/j.crohns.2013.02.015.
57. Moftah M, Nazour F, Cunningham M et al. Single port laparoscopic surgery for patients with complex and recurrent Crohn’s disease. J Crohns Colitis 2014; 8 (9): 1055–1061. doi: 10.1016/j.crohns. 2014.02.003.
58. Sangster W, Messaris E, Berg AS et al. Single-site laparoscopic colorectal surgery provides similar clinical outcomes compared to standard laparoscopic surgery: an analysis of 626 patients. Dis Colon Rectum 2015; 58 (9): 862–869. doi: 10.1097/DCR.0000000000000435.
59. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 1978; 2 (6130): 85–88.
60. Hata K, Kazama S, Nozawa H et al. Laparoscopic surgery for ulcerative colitis: a review of the literature. Surg Today 2015; 45 (8): 933–938. doi: 10.1007/s00595-014-1053-7.
61. Øresland T, Bemelman WA, Sampietro GM et al. European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis 2015; 9 (1): 4–25. doi: 10.1016/j.crohns.2014.08.012.
62. Polle SW, Dunker MS, Slors JF et al. Body image, cosmesis, quality of life, and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial. Surg Endosc 2007; 21 (8): 1301–1307.
63. Wu XJ, He XS, Zhou XY et al. The role of laparoscopic surgery for ulcerative colitis: systematic review with meta-analysis. Int J Colorectal Dis 2010; 25 (8): 949–957. doi: 10.1007/s00384-010-0898-5.
64. Fleming FJ, Francone TD, Kim MJ et al. A laparoscopic approach does reduce short-term complications in patients undergoing ileal pouch-anal anastomosis. Dis Colon Rectum 2011; 54 (2): 176–182. doi: 10.1007/DCR.0b013e3181fb4232.
65. Maggiori L, Panis Y. Surgical management of IBD – from an open to a laparoscopic approach. Nat Rev Gastroenterol Hepatol 2013; 10 (5): 297–306. doi: 10.1038/nrgastro.2013.30.
66. Fajardo AD, Dharmarajan S, George V et al. Laparoscopicversus open 2-stage ileal pouch: laparoscopic approach allows for faster restoration of intestinal continuity. J Am Coll Surg 2010; 211 (3): 377–383. doi: 10.1016/j.jamcollsurg.2010.05.018.
67. Waljee A, Waljee J, Morris AM et al. Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut 2006; 55 (11): 1575–1580.
68. Rajaratnam SG, Eglinton TW, Hider P et al. Impact of ileal pouch-anal anastomosis on female fertility: meta-analysis and systematic review. Int J Colorectal Dis 2011; 26 (11): 1365–1374. doi: 10.1007/s00384-011-1274-9.
69. Cornish JA, Tan E, Teare J et al. The effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy and delivery: a systematic review. Dis Colon Rectum 2007; 50 (8): 1128–1138.
70. Bartels SAL, D’Hoore A, Cuesta MA et al. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg 2012; 256 (6): 1045–1048. doi: 10.1097/SLA.0b013e318250caa9.
71. Watanabe K, Funayama Y, Fukushima K et al. Hand-assisted laparoscopic vs. open subtotal colectomy for severe ulcerative colitis. Dis Colon Rectum 2009; 52 (4): 640–645. doi: 10.1007/DCR.0b013e 31819d47b5.
72. Bartels SL, Gardenbroek TJ, Ubbink DT et al. Systematic review and meta-analysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis. Br J Surg 2013; 100 (6): 726–733. doi: 10.1002/bjs.9061.
73. Gu J, Stocchi L, Remzi FH et al. Total abdominal colectomy for severe ulcerative colitis: does the laparoscopic approach really have benefit? Surg Endosc 2014; 28 (2): 617–625. doi: 10.1007/s00464-013-3218-7.
74. Pandey S, Luther G, Umanskiy K et al. Minimally invasive pouch surgery for ulcerative colitis: is there a benefit in staging? Dis Colon Rectum 2011; 54 (3): 306–310. doi: 10.1007/DCR.0b013e31820347b4.
75. Farraye FA, Odze RD, Eaden J et al. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology 2010; 138 (2): 738–745. doi: 10.1053/j.gastro.2009.12.037.
76. Chatzizacharias NA, Torrente F, Brennan M et al. Single port laparoscopic subtotal colectomy and ileostomy in an adolescent with ulcerative colitis. J Crohns Colitis 2012; 6 (10): 1031–1033. doi: 10.1016/j.crohns.2012.03.011.
77. Geisler DP, Condon ET, Remzi FH. Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 2010; 12 (9): 941–943. doi: 10.1111/j.1463-1318.2009.02115.x.
78. Fung AK, Aly EH. Robotic colonic surgery: is it advisable to commence a new learning curve? Dis Colon Rectum 2013; 56 (6): 786–796. doi: 10.1097/DCR.0b013e 318285b810.
79. Mikocka-Walus AA, Turnbull DA, Andrews JM et al. Psychological problems in gastroenterology outpatients: a South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C. Clin Pract Epidemiol Ment Health 2008; 4: 15. doi: 10.1186/1745-0179-4-15.
80. Gavrilescu O, Mihai C, Anton-Paduraru DT et al. Impact of inflammatory bowel diseases on quality of life. Revista de Cercetare si Interventie Sociala 2015; 50: 80–95.
81. Love JR, Irvine EJ, Fedorak RN. Quality of life in inflammatory bowel disease. J Clin Gastroenterol 1992; 14 (1): 15–19.
82. Casellas F, López-Vivancos J, Badia X et al. Impact of surgery for Crohn’s disease on health-related quality of life. Am J Gastroenterol 2000; 95 (1): 177–182.
83. Delaney CP, Kiran RP, Senagore AJ et al. Quality of life improves within 30 days of surgery for Crohn’s disease. J Am Coll Surg 2003; 196 (5): 714–721.
84. Kunovský L, Kala Z, Mitáš L et al. Quality of life after bowel resection for Crohn’s disease – first results. Rozhl Chir 2016; 95 (12): 444–448.
85. Cohen RD. The quality of life in patients with Crohn’s disease. Aliment Pharmacol Ther 2002; 16 (9): 1603–1609.
86. Thaler K, Dinnewitzer A, Oberwalder M et al. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn’s disease. Colorectal Dis 2005; 7 (4): 375–381.
87. Scarpa M, Ruffolo C, Bassi D et al. Intestinal surgery for Crohn’s disease: predictors of recovery, quality of life, and costs. J Gastrointest Surg 2009; 13 (12): 2128–2135. doi: 10.1007/s11605-009-1044-y.
88. Wexner SD, Cera SM. Laparoscopic surgery for ulcerative colitis. Surg Clin North Am 2005; 85 (1): 35–47.
89. Maartense S, Dunker MS, Slors JF et al. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis. Ann Surg 2004; 240 (6): 984–991.
90. Larson DW, Dozois EJ, Piotrowicz K et al. Laparoscopic-assisted vs. open ileal pouch-anal anastomosis: functional outcome in a case-matched series. Dis Colon Rectum 2005; 48 (10): 1845–1850.
91. Ahmed Ali U, Keus F, Heikens JT et al. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev 2009; 1: CD006267. doi: 10.1002/14651858.CD006267.pub2.
92. Lix LM, Graff LA, Walker JR et al. Longitudinal study of quality of life and psychological functioning for active, fluctu-ating, and inactive disease patterns in inflammatory bowel disease. Inflamm Bowel Dis 2008; 14 (11): 1575–1584. doi: 10.1002/ibd.20511.