Ulcerative colitis (UC) is a relapsing and remitting disease characterized by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of the inflammation. But for a long time, the majority of doctors and patients in China show an excessive dependence on medication and ignore the importance of surgical treatment. This has seriously affected the overall level of UC treatment in China and resulted in a poor prognosis of some patients. Abandoning obsolete concept, grasping the operation timing, selecting the proper operation mode, enhancing surgical technique and founding a multi-disciplinary team, are the key to successfully curing UC.
China ; Colitis, Ulcerative ; surgery ; Humans

Despite significant progress in medical therapy for ulcerative colitis, surgical intervention is still required in a portion of patients with ulcerative colitis. Ileal pouch-anal anastomosis has been commonly used in western countries, while ileorectal anastomosis may be appropriate in specific scenarios. The surgical decision should be made based upon the clinical situation and sufficient patient consent.
Anastomosis, Surgical ; Colitis, Ulcerative ; surgery ; Humans

OBJECTIVETo compare the safety and feasibility of laparoscopic surgery and open surgery in ulcerative colitis.

METHODSA search of published studies in English and Chinese between January 1992 and May 2008 was performed. Nine hundred and twenty-three patients from 16 studies were recruited which met the inclusion criteria. Meta-analysis was performed through fixed effect model or random effect model dependent on heterogeneity.

RESULTSCompared to open procedure, patients with ulcerative colitis undergone laparoscopic surgery were able to tolerate oral intake significantly earlier (P<0.01) with shorter hospital stay (P<0.01) and had lower total complication rate (P<0.01). But duration of laparoscopic surgery was significantly longer than that of open procedure(P=0.04). Laparoscopic procedure was no more superior to open procedure in recovery of bowel function, re-operation rate, intra-abdominal abscess, anastomotic leak, postoperative bowel obstruction, wound infection, blood loss and mortality. The conversion rate was 4.2% in this analysis.

CONCLUSIONLaparoscopic surgery for ulcerative colitis is safe and feasible with better recovery in short-term as compared to the open procedure.

Colitis, Ulcerative ; surgery ; Humans ; Laparoscopy ; Laparotomy ; Safety ; Treatment Outcome

The inflammatory bowel diseases (IBDs), consisting of ulcerative colitis (UC) and Crohn's disease (CD), are characterized by idiopathic, chronic inflammation of the gastrointestinal tract. The overall incidence of IBDs is constantly increasing in eastern countries. In comparison with the data from western nations, in China, the incidence of male IBDs is relatively higher, the onset age is older. The severity of most cases is mild to moderate. The occurrence of fistula and peri-anal involvement are rare. Although significant improvements of IBDs therapy have been achieved in recent years, there are still over 30% UC and 70% CD cases need at least one surgery throughout their life span. Here we review the literatures published in recent years about the surgical management of IBDs.
Colitis, Ulcerative ; surgery ; Crohn Disease ; surgery ; Humans ; Inflammatory Bowel Diseases ; surgery

To analyze the clinical features and prognosis of ulcerative colitis(UC)complicated with acute massive lower gastrointestinal bleeding(LGIB). Methods Eleven patients hospitalized in Peking Union Medical College Hospital from January 2006 to December 2017 for treatment of UC,suffering from acute massive LGIB,were enrolled and descriptively analyzed. Results The proportion of UC patients with acute massive LGIB was 0.7% among all 1486 UC patients hospitalized during the study period.The disease was moderately or severely active in these 11 patients,among whom 9 patients(81.8%)had chronic relapsing pancolitis.Cytomegalovirus infection was present in 5 patients,among whom 4 patients received antiviral treatments.All the 11 patients received treatments including food and water fasting,rehydration,blood transfusion,and use of somatostatin.Four patients received emergency surgical treatment after the first episode of massive bleeding,and 3 of them suffered from re-bleeding after the surgery.Among the remaining seven patients,two underwent emergency total colectomy+subtotal rectectomy+ileostomy and three received elective total resection of colon and rectum or total colectomy+subtotal rectectomy+ileostomy.Thus,9 patients underwent emergency surgery,1 patient did not receive surgey during follow-up,and 1 patient was lost to follow-up. Conclusions Acute massive LGIB is a manifestation of active UC and can be associated with poor prognosis.Optimized perioperative management is important for improving the outcomes of such patients.
Colectomy ; Colitis, Ulcerative ; complications ; diagnosis ; surgery ; Gastrointestinal Hemorrhage ; complications ; surgery ; Humans ; Ileostomy ; Prognosis

Recent reports have demonstrated a negative association between appendectomy and ulcerative colitis. Many retrospective studies have shown that appendectomy appears to be protective against ulcerative colitis. Although the function of appendix is not known, all these studies have suggested that alterations in mucosal immune responses leading to appendicitis or resulting from appendectomy may negatively affect the pathogenic mechanisms of ulcerative colitis. Herein, we report a 45-year-old man who was diagnosed as severe ulcerative colitis 2 years ago. Colonoscopy revealed a feature of pancolitis. He has been treated with several courses of corticosteroids over 2 years. However, dosage of steroid was not tappered down because of the recurrence of symptoms. He was admitted with a diagnosis of acute appendicitis, and underwent appendectomy. Two months after the appendectomy, clinical symptoms and colonoscopic findings improved gradually. Two years after the appendectomy, the patient improved without the recurrences of symptoms, and is stably treated with sulfasalazine alone.
*Appendectomy ; Appendicitis/complications/*surgery ; Colitis, Ulcerative/complications/*physiopathology ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the role of different procedures in the treatment of severe ulcerative colitis (UC) requiring colectomy.

METHODSA total of 29 UC inpatients who underwent colectomy at the West China Hospital between January 1996 and December 2008 were included in this study. Except two cases who underwent partial colectomy, patients were divided into total colectomy group (TC group, n=7) and total proctocolectomy group (TPC group, n=20), meanwhile divided into ileal pouch-anal anastomosis (IPAA, n=8) group, straight end-to-end anastomosis (ileoanal or ileorectal and ileostomy) group (n=14)and ileostomy group (n=5). Quality of life (QOL) was assessed using the Cleveland Global Quality of Life (CGQL) instrument.

RESULTSThe complication rate was 60.0% in TPC group and 57.1% in TC group (P>0.05). The recurrence rate was 15.0% in TPC group and 57.1% in TC group (P<0.05). The complication rate was 6/8 in IPAA group and 50.0% (7/14) in straight end-to-end anastomosis group (P>0.05). The frequency of daily bowel movements in IPAA group was significantly lower than that in straight end-to-end anastomosis group at 1 year after the surgery (5.6+/-1.7 versus 9.1+/-2.9, P<0.05). QOL was significantly improved postoperatively for all the patients(P<0.01). Patients who underwent IPAA had a better QOL than those of straight end-to-end anastomosis group (P>0.05).

CONCLUSIONSTPC-IPAA is the ideal procedure of severe UC with acceptable complication rate, satisfactory quality of life and functional outcome.

Adolescent ; Adult ; Aged ; Colitis, Ulcerative ; surgery ; Humans ; Middle Aged ; Quality of Life ; Treatment Outcome ; Young Adult

Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments can induce and maintain remission. Approximately 25% of patients with UC ultimately require colectomy for ineffective medical treatment or complications. Ileal pouch-anal anastomosis(IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy.Improvement in pouch technique may decrease the perioperative complication rate and postoperative stool frequency. Laparoscopic IP AA can lessen surgical trauma,abdominal adhesion and intestinal obstruction. Timing of surgery, appropriate surgical technique , and prevention of postoperative complications are the keys to successful treatment of UC.
Anal Canal ; surgery ; Anastomosis, Surgical ; Colectomy ; Colitis, Ulcerative ; surgery ; Humans ; Ileum ; surgery ; Intestinal Obstruction ; Laparoscopy ; Postoperative Complications ; Recurrence

PURPOSE: Inflammatory bowel disease (IBD) in Korea has been increasing in recent years, but accurate statistics about operations for IBD are lacking. The purpose of this study was to investigate the trends and current status of IBD surgeries in Korea. METHODS: Using a national database from the Korea Health Insurance Review and Assessment Service, we analyzed data from patients who underwent surgery for Crohn disease and ulcerative colitis from January 2009 to October 2016. RESULTS: The mean number of patients who underwent surgery for Crohn disease was 791.8 per year. Colorectal surgery, small bowel surgery, and anal surgery were performed fairly often (31.2%, 29.4%, 39.4%, respectively), and laparoscopic surgery continued to increase, recently exceeding 30%. About 50% of Crohn patients used biologics before and after surgery, and those patients also underwent a relatively high rate of anal surgeries (44.2%). The mean number of patients who underwent surgery for ulcerative colitis was 247.6 per year. Colorectal surgery accounted for more than half of all operations, and laparoscopic surgery has been increasing rapidly, having been performed in about 60% of patients in recent years. The incidence of colorectal cancer in patients with ulcerative colitis was very high and increased rapidly during the study period, reaching about 80%. CONCLUSION: The number of patients undergoing laparoscopic surgery for IBD in Korea has increased significantly. Biologics are actively used by patients with Crohn disease, with a high proportion of anal surgeries required. Many of the surgical indications for ulcerative colitis have shifted into colorectal cancer.
Biological Products ; Colitis, Ulcerative ; Colorectal Neoplasms ; Colorectal Surgery ; Crohn Disease ; Humans ; Incidence ; Inflammatory Bowel Diseases* ; Insurance, Health ; Korea* ; Laparoscopy

Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal anastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after restorative proctocolectomy. A total of sixteen patients underwent surgery between January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and familial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n=2), leak (n=1) and perianal abscess (n=1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 months after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence was shown in 12/15, and 5/15, respectively in period 1, but improved to 10/11, and 10/11, respectively in period 2. Night time incontinence was noted in 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to take anti-diarrheal medication, and to use a pad was noted in 2/15, and 10/15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was satisfactory in 13/14 patients. Postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) and satisfactory sexual life (5/5). In females, 3 patients showed a satisfactory sexual life. In conclusion, restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.
Adenomatous Polyposis Coli/surgery ; Adult ; Colitis, Ulcerative/surgery ; Defecation ; Ejaculation ; Female ; Human ; Male ; Patient Satisfaction ; Penile Erection ; Proctocolectomy, Restorative*/adverse effects ; Safety ; Sex Behavior ; Treatment Outcome