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World J Gastroenterol. Dec 14, 2012; 18(46): 6756-6763
Published online Dec 14, 2012. doi: 10.3748/wjg.v18.i46.6756
Minimally invasive approaches for the treatment of inflammatory bowel disease
Marco Zoccali, Alessandro Fichera
Marco Zoccali, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
Alessandro Fichera, Department of Surgery, University of Washington Medical Center, Seattle, WA 98195, United States
Author contributions: Zoccali M and Fichera A equally contributed to conception and design of the paper; Zoccali M was responsible for searching the literature, interpreting data and drafting the article; Fichera A was responsible for revising the article critically for important intellectual content and gave final approval of the version to be submitted and any revised version to be published.
Correspondence to: Alessandro Fichera, MD, FACS, FASCRS, Professor, Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Box 356410, Room BB-414, Seattle, WA 98195, United States. afichera@surgery.bsd.uchicago.edu
Telephone: +1-206-6165709 Fax: +1-206-5438136
Received: April 18, 2012
Revised: July 13, 2012
Accepted: August 4, 2012
Published online: December 14, 2012
Abstract

Despite significant improvements in medical management of inflammatory bowel disease, many of these patients still require surgery at some point in the course of their disease. Their young age and poor general conditions, worsened by the aggressive medical treatments, make minimally invasive approaches particularly enticing to this patient population. However, the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting, currently mostly pursued in high-volume referral centers, despite accumulating evidences in the literature supporting the benefits of minimally invasive surgery. The largest body of evidence currently available for terminal ileal Crohn’s disease shows improved short term outcomes after laparoscopic surgery, with prolonged operative times. For Crohn’s colitis, high quality evidence supporting laparoscopic surgery is lacking. Encouraging preliminary results have been obtained with the adoption of laparoscopic restorative total proctocolectomy for the treatment of ulcerative colitis. A consensus about patients’ selection and the need for staging has not been reached yet. Despite the lack of conclusive evidence, a wave of enthusiasm is pushing towards less invasive strategies, to further minimize surgical trauma, with single incision laparoscopic surgery being the most realistic future development.

Keywords: Laparoscopic surgery; Inflammatory bowel disease; Ulcerative colitis; Crohn’s disease