• improving health outcomes
• inflammatory bowel disease
• minimally invasive surgery
• public health care
• robotic assited surgery

• Humans
• Proctocolectomy, Restorative/methods
• Proctocolectomy, Restorative/adverse effects
• Colonic Pouches/adverse effects
• Laparoscopy/methods
• Colitis, Ulcerative/surgery
• Anastomosis, Surgical/methods
• Anastomosis, Surgical/adverse effects
• Crohn Disease/surgery
• Minimally Invasive Surgical Procedures/methods

The initial operation of choice in many patients presenting as an emergency with ulcerative colitis is a subtotal colectomy with end ileostomy. A percentage of patients do not proceed to completion proctectomy with ileal pouch anal anastomosis.

To review the existing literature in relation to the significant long-term complic-ations associated with the rectal stump, to provide an overview of options for the surgical management of remnant rectum and anal canal and to form a consolidated guideline on endoscopic screening recommendations in this cohort.

A systematic review was carried out in accordance with PRISMA guidelines for papers containing recommendations for endoscopy surveillance in rectal remnants in ulcerative colitis. A secondary narrative review was carried out exploring the medical and surgical management options for the retained rectum.

For rectal stump surveillance guidelines, 20% recommended an interval of 6 mo to a year, 50% recommended yearly surveillance 10% recommended 2 yearly surveillance and the remaining 30% recommended risk stratification of patients and different screening intervals based on this. All studies agreed surveillance should be carried out via endoscopy and biopsy. Increased vigilance is needed in endoscopy in these patients. Literature review revealed a number of options for surgical management of the remnant rectum.

The retained rectal stump needs to be surveyed endoscopically according to risk stratification. Great care must be taken to avoid rectal perforation and pelvic sepsis at time of endoscopy. If completion proctectomy is indicated the authors favour removal of the anal canal using an intersphincteric dissection technique.

• Stump
• Ulcerative colitis
• Surveillance
• Endoscopy
• Rectal
• Screening

Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site incision. While intuitively appealing, there is sparse evidence for its use beyond feasibility.

To examine the usefulness of single access laparoscopy (SAL) in a general series experience of patients sick with ulcerative colitis.

All patients presenting electively, urgently or emergently over a three-year period under a colorectal specialist team were studied. SAL was performed via the stoma site on a near-consecutive basis by one surgical team using a “surgical glove port” allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport surgery. Standard, straight rigid laparoscopic instrumentation were used without additional resource.

Of 46 consecutive patients requiring surgery, 39 (85%) had their procedure begun laparoscopically. 27 (69%) of these were commenced by single port access with an 89% completion rate thereafter (three were concluded by multi-trocar laparoscopy). SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs (> 100€case) and postoperative hospital stay (median 5 d vs 7.5 d, P = 0.045) without increasing operative time. It proved especially efficient in those with preoperative albumin > 30 g/dL (n = 20). Its comparative advantages were further confirmed in ten pairs case-matched for gender, body mass index and preoperative albumin. SAL outcomes proved durable in the intermediate term (median follow-up = 20 mo).

Single port total colectomy proved useful in planned and acute settings for patients with medically refractory colitis. Assumptions regarding duration and cost should not be barriers to its implementation.

• Single incision laparoscopy
• Minimal access surgery
• Inflammatory bowel disease
• Ulcerative colitis
• Total colectomy and end ileostomy
• Case match analysis

• Colectomy/adverse effects
• Colitis, Ulcerative/surgery
• Humans
• Ileostomy/adverse effects
• Laparoscopy/adverse effects
• Length of Stay
• Treatment Outcome

• acute severe colitis
• colectomy
• inflammatory bowel disease
• laparoscopy
• outcomes
• surgery
• surgical technique

• Inflammatory bowel diseases
• Laparoscopy
• Morbidity
• Mortality
• Percorso Diagnostico Terapeutico Assistenziale
• Restorative proctocolectomy
• Surgery
• Ulcerative colitis

• Age Factors
• Colectomy/methods
• Colonic Neoplasms/complications
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Humans
• Laparoscopy
• Neoplasm Staging
• Treatment Outcome

Background. The incidence of inflammatory bowel disease (IBD) is increasing in the paediatric population. Since 2007, a single surgeon whose main practice is in the treatment of adults has performed surgery for IBD in adults and children within two dedicated multidisciplinary teams. Our aim was to assess and compare outcomes for adults and children following surgery for IBD. Methods. Analysis of a prospectively collected database was carried out to include all patients who had undergone resectional surgery for IBD between 2007 and 2012. Results. 48 adults and 30 children were included in the study. Median age for children was 14 years (range 8–16) and for adults was 33.5 years (range 17–64). Median BMI was 23 (range 18–38) and 19 (range 13–29.5) in adults and children, respectively (P < 0.001). Laparoscopic resection was performed in 27 (90%) children and 36 (75%) adults. Postoperative complication rates were comparable, 11 (23%) in adults versus 6 (20%) in children (P = 1.00). Conclusion. Resectional surgery for IBD in children has outcomes that compare favourably with the adult population, with the majority of cases being performed by a laparoscopic approach.

• advancements
• crohn's disease
• diagnosis
• management
• review
• treatment
• update
• ulcerative colitis

• Antibodies, Monoclonal, Humanized/therapeutic use
• Biomarkers/analysis
• Capsule Endoscopy
• Cell Migration Inhibition/drug effects
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/surgery
• Colitis, Ulcerative/therapy
• Colonic Pouches
• Crohn Disease/diagnosis
• Crohn Disease/surgery
• Crohn Disease/therapy
• Diagnosis, Differential
• Feces/chemistry
• Humans
• Intestine, Small/diagnostic imaging
• Lactoferrin/analysis
• Magnetic Resonance Imaging
• Natalizumab
• Sensitivity and Specificity
• Standard of Care
• Tomography, X-Ray Computed
• Treatment Outcome
• Ultrasonography

The intraumbilical incision is being used more frequently, with increasing cases of single incision laparoscopic surgery. Since the umbilicus is deeper than the surrounding wall, it has abundant bacteria. No study has compared the adverse outcomes of periumbilical and intraumbilical incisions. We analyzed the wound complication rates of perforated appendicitis patients according to the types of umbilical incision.

A retrospective review was done of 280 patients with perforated appendicitis. One hundred fifty nine patients were treated with the intraumbilical incision, and 121 patients were treated with the periumbilical incision. We compared the perioperative outcomes according to each laparoscopic incision.

There was no difference in operation time, postoperative hospital stay and analgesic requirement between the two groups. One case in the intraumbilical group (0.6%) and three cases in the periumbilical group (2.5%) developed wound infections. The umbilical complication rate showed no difference.

The wound complication rate of intraumbilical and periumbilical incisions are not different. Although this retrospective study has inherent limitations, the intraumbilical incision seems to be a safe and feasible alternative for the periumbilical incision that can be easier to perform, with better cosmetic results.

• Appendectomy
• Intraumbilical
• Laparoscopic technique