Controversies in Pouch Surgery for Ulcerative Colitis.

, Yu, Chang Sik

doi:2009.25.3.207

Search: J Korean Soc Coloproctol Search

CLOSE

Review

Journal of the Korean Society of Coloproctology 2009;25(3):207-211.
DOI: https://doi.org/10.3393/jksc.2009.25.3.207

Controversies in Pouch Surgery for Ulcerative Colitis.

Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. csyu@amc.seoul.kr

Abstract

Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn's disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn's disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings.

Key Words: Ulcerative colitis; Mucosectomy; Stapled anastomosis; Ileostomy; Indeterminate colitis

TOOLS

Share :

METRICS

0 Crossref
Scopus
15,435 View
8 Download

Related articles in ACP

Analysis of the Results of Surgical Treatment Options for Ulcerative Colitis.1997 March;13(1)

A Clinical Analysis of the Ulcerative Colitis.1997 September;13(3)

Clinical Analysis of Ulcerative Colitis.1998 June;14(2)

A Case of Non-Hodgkin's Lymphoma in Ulcerative Colitis.2005 February;21(1)

Laparoscopic Surgery for Splenic Flexure Colon Cancer.2007 June;23(3)

ABOUT

ARTICLE CATEGORY

Browse all articles >

BROWSE ARTICLES

AUTHOR INFORMATION

Editorial Office: Room 1519, Suseo Hyundai Venture-vill, 10 Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Korea
Tel: +82-2-2040-7737 Fax: +82-2-2040-7735 E-mail: editor@coloproctol.org