Tjibbe J. Gardenbroek

The effect of appendectomy on the course of ulcerative colitis: a systematic review

Aim  Previous studies have shown significantly lower appendectomy rates in ulcerative colitis (UC) patients compared with healthy controls. Evidence indicating that the appendix has an immunomodulatory role in UC has been accumulating. To examine the latest evidence on the effect of appendectomy on the disease course of UC.

Single-port versus multiport laparoscopic ileocecal resection for Crohn's disease

BACKGROUND AND AIMS Several case series have demonstrated the feasibility of single-port laparoscopic ileocecal resection in Crohns disease. However, only a few studies compared the single-port with a multiport laparoscopic ileocecal approach. The aim of this study was to compare short term surgical outcome parameters between single-port and multiport laparoscopic ileocecal resections for Crohns disease. METHODS Twenty-one patients who underwent single-port laparoscopic ileocecal resection between March 2010 and September 2012 were prospectively registered. A matched comparison on a 1:2 basis was performed with patients who underwent multiport laparoscopic ileocecal resection from January 1999 to March 2010. Matching parameters were BMI, length of diseased bowel resected and the presence of fistulas. Endpoints were the length of postoperative hospital stay, operative time, conversions, complications, postoperative pain scores and postoperative analgesia consumption. RESULTS Twenty-one patients undergoing single-port resection were matched to 42 patients undergoing multiport resection. The postoperative stay (4 days, iqr 4-5 vs. 5 days, iqr 4-6; p=0.033), operative time (103 min, iqr 94.0-121.0 vs. 123.5 min, iqr 100.0-157.0; p=0.036) and morphine use on the first postoperative day (12.5 mg, iqr 5.0-33.3 vs. 28 mg, 15.0-50.0; p=0.012) differed significantly. Postoperative pain scores and complications were similar in both groups. This study was limited by potential selection bias. CONCLUSIONS Single-port laparoscopic ileocecal resection is safe and feasible in Crohns disease and is associated with less need for pain medication postoperatively as opposed to multiport laparoscopic ileocecal resection.

Early reconstruction of the leaking ileal pouch‐anal anastomosis: a novel solution to an old problem

The study aimed to determine the effectiveness and direct medical costs of early surgical closure of the anastomotic defect after a short course of Endo‐sponge® therapy of the presacral cavity, compared with conventional treatment in patients with anastomotic leakage after ileal pouch‐anal anastomosis (IPAA).

Health-related quality of life and disability in patients with ulcerative colitis and proctocolectomy with ileoanal pouch versus treatment with anti-TNF agents

BACKGROUND AND AIMS We compared health-related quality of life (HRQL) and disability in ulcerative colitis (UC) patients in remission with anti-tumor necrosis factor agents (TNF) or after restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA). METHODS Two patient cohorts were studied. The first group consisted of patients in remission after RPC with IPAA (surgery group). The second group consisted of patients in remission with infliximab or adalimumab (medical group). For inclusion in the surgery group the pouch had to be functional for ≥1year and patients were excluded in case of postoperative complications. In the medical group, patients had to be on maintenance therapy with anti-TNF agents for ≥1year and in clinical remission. HRQL and disability outcomes were assessed using SF-36, COREFO, WPAI:UC and EORTC questionnaires. RESULTS 60 patients were included, 30 patients in both groups. 58 out of 60 patients (97%) returned the completed questionnaires: 29 patients in the surgery group (median age 42 years [22-67]; 48% female) and 29 patients in the medical group (median age 45 years [19-68]; 65% female). Patient characteristics were comparable between the two groups. There were no significant differences in SF-36, WPAI:UC and EORTC questionnaires between both groups, except for the medication and stool frequency scale (COREFO questionnaire) that was significantly higher in the surgery vs. the medical group (p=0.004 and p<0.001, respectively). CONCLUSION HRQL and disability were not different among the medical and surgical group, except for stool frequency and anti-diarrhea medication use that was significantly higher in surgically treated patients.

Alternative specimen extraction techniques after laparoscopic emergency colectomy in inflammatory bowel disease

BackgroundOmitting the extraction site incision potentially further decreases the abdominal wall trauma in laparoscopic surgery. The purpose of this study was to report the results of alternative specimen extraction techniques after laparoscopic emergency colectomy in patients with inflammatory bowel disease (IBD).MethodsTen consecutive patients with IBD underwent (sub)acute emergency colectomy for refractory disease from October 2009 until December 2010. The specimen was retrieved via the stoma site in three and transrectally in seven patients. Patient data were prospectively collected. In case of later completion proctectomy and pouch procedure, adhesions were systematically scored.ResultsThe extraction techniques were all feasible. Median operative time was 219 (interquartile range (IQR), 197–232) min. The pain scores and morphine requirement in patients decreased quickly after surgery. No infectious complications occurred. In five patients, a completion proctectomy was performed at a median time of 7 (IQR, 3.8–9.3) months after colectomy. All patients showed absence of any adhesions in the pelvis. In two patients, limited adhesions of the cut side of the mesentery were present.ConclusionsSpecimen extraction via the rectum or stoma site is a safe, alternative way to extract the specimen after laparoscopic colectomy. No infectious complications were observed postoperatively and no pelvic adhesions were found during completion proctectomy.

Prolonged preoperative hospital stay is a risk factor for complications after emergency colectomy for severe colitis

Risk factors for postoperative complications in patients undergoing emergency colectomy for severe colitis in inflammatory bowel disease have hardly been studied. Therefore, this study aimed to define predictors of a complicated postoperative course in these patients.

Surgery for Crohn's Disease: New Developments

Background/Aims: Crohn’s disease is a chronic relapsing inflammatory bowel disease requiring surgery in a large number of patients. This review describes new developments in surgical techniques for treating Crohn’s disease. Results: Single-incision laparoscopic surgery decreases abdominal wall trauma by reducing the number of abdominal incisions, possibly improving postoperative results in terms of pain and cosmetics. The resected specimen can be extracted through the single-incision site or the future stoma site. Another option is to use natural orifices for extraction (i.e. transcolonic/transanal), but actual benefits of these procedures have not yet been determined. In patients with extensive perianal disease or rectal involvement, transperineal completion proctectomy is often feasible, thereby avoiding relaparotomy. By using a close rectal intersphincteric resection, damage to the pelvic autonomic nerves is avoided. In addition, the risk of presacral abscess formation is reduced by leaving the mesorectal tissue behind. Conclusion: Minimally invasive surgery and associated techniques have become standard clinical practice in surgical treatment of patients with Crohn’s disease. New developments aim at further reducing the hospital stay and morbidity, and improving the cosmetic outcomes.

Lymphocytes populations in appendiceal lavage fluid predictive of IBD-related inflammation

Until recently the appendix was mostly seen as a rudimentary part of the human intestine, but nowadays it has been demonstrated to havea distinct immunological function. Reports are emerging linking this vermiform organ to the development of ulcerative colitis (UC) and a systematic review suggests that an appendectomy could modulate the disease course.1 In addition, various animal studies have shown that the removal of the appendix prevents the development of experimental colitis, which further supports this hypothesis.2,3

P105 Active inflammation of the appendix in ulcerative colitis

observed in the reduction for the group previously treated with biologics (p 0.24). Conclusions: The availability of controlled clinical trials has allowed investigators to count on an additional tool for the treatment of the UC. In our population we found a decrease of the disease activity measured by the Mayo score with standard doses of ADA at 12 weeks. While ADA induces a clinical remission according to the Mayo Score, no statistically significant reduction was seen for the endoscopic index in the biologics naive group, so we must consider the extension and the disease activity for this group of patients.