Examining Surgical Options for Ulcerative Colitis

Laparoscopic surgery for ulcerative colitis linked to better short term and long term outcomes than open surgery

(RxWiki News) When facing surgery, many patients have to decide between newer techniques versus old standards. A new review compared two such types of surgery for patients with gastrointestinal issues.

The review considered the benefits and disadvantages of more minimally invasive laparoscopic surgery versus traditional open surgery for patients with ulcerative colitis.

The authors of this review found that though further research is needed, laparoscopic surgery has been associated with better short- and long-term results, plus shorter recovery periods.

"Try a food diary to track which foods trigger your gastrointestinal symptoms."

In ulcerative colitis, an inflammatory bowel disease (IBD), the large intestine is chronically inflamed, leading to small ulcers and uncomfortable symptoms like abdominal pain and diarrhea.

According to the authors of this study, led by Christianne J. Buskens, MD, PhD, Consultant Colorectal Surgeon at the Academic Medical Center in Amsterdam, The Netherlands, though there are now more options for treating ulcerative colitis, 35 percent of patients still require surgery.

Dr. Buskens and team explained that the preferred surgical procedure for ulcerative colitis is called total colectomy with ileal pouch-anal anastomosis (IPAA) — a procedure that involves the removal of the large intestine and the sewing together of the small intestine and the rectum.

The procedure can be performed by hand with a single large incision — the traditional, "open" surgery — or as a laparoscopic surgery — a newer, minimally invasive method which uses several small incisions, small surgical tools and a camera and screens to view the procedure.

The researchers aimed to compare the benefits and disadvantages between the two surgery types by reviewing studies, analyses and reviews on the topic.

In one analysis involving 607 ulcerative colitis patients, there were no major differences between either method in terms of short-term risk for death or complications. And while the in-surgery time was an average of 91 minutes longer for laparoscopic procedures, this method was also associated with a hospital stay that was, on average, 2.66 days shorter.

The researchers noted that as time has gone on and the laparoscopic method has been improved upon, short-term results from this type of procedure have also seemed to improve.

When looking at long-term outcomes, the review authors examined an analysis of 53 different studies involving 14,966 ulcerative colitis patients. This analysis showed similar functional outcome of both types of surgery an average of five years later, with both types having only around a 4.7 percent failure rate.

Dr. Buskens and colleagues also examined a study that looked at results an average of 2.7 years after surgery. This study found similar results for function, quality of life and complications between the two methods, though the laparoscopic group seemed to have better body image scores.

Dr. Buskens and team did note that in cases of severe acute colitis — considered a medical emergency — laparoscopy was associated with a reduced risk for infections and shorter hospital stays.

The review authors concluded that as a major surgical advance, laparoscopic surgery is associated with a "learning curve" as the procedure is perfected. However, they wrote that there is evidence suggesting benefits in both the short term and long term for laparoscopic versus open surgery.

"Nowadays, there is increasing solid data from audit studies suggesting that laparoscopic surgery is also associated with lower risks of mortality and morbidity, adding to the conclusion that laparoscopy should become the standard of care for [ulcerative colitis] patients," wrote Dr. Buskens and team. "Perhaps the time is right to identify selection criteria for open surgery, rather than identifying good candidates for laparoscopy?"

Further research is needed to more closely compare the two surgical treatment options and better understand the advantages and disadvantages of each.

This study was published in the February issue of Best Practice & Research Clinical Gastroenterology. No conflicts of interest were reported.

Review Date: 
February 21, 2014