Up-to-date surgery for ulcerative colitis in the era of biologics |
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Authors: | Takayuki Yamamoto Michele Carvello Antonino Spinelli Paulo Gustavo Kotze |
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Institution: | 1. Inflammatory Bowel Disease Center &2. Department of Surgery, Yokkaichi Hazu Medical Center, Yokkaichi, Japan;3. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Milano, Italy;4. Department of Biomedical Sciences, Humanitas University, Milan, Italy;5. IBD outpatient clinics, Colorectal Surgery Unit, Catholic University of Parana (PUCPR), Curitiba, Brazil |
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Abstract: | ABSTRACTIntroduction: In recent decades, biologics have resulted in significantly improved medical management of ulcerative colitis (UC). Rates of surgery for UC are declining. However, there is still a controversial question of the relation of biologics to postoperative adverse outcomes and the most appropriate timing for operative intervention.Areas covered: In this review, we explore the updated treatment algorithm of acute severe colitis, describe postoperative outcomes in patients exposed to biologics preoperatively, and discuss the primary indications for staging surgery in chronic refractory cases, largely with prolonged medical therapy.Expert opinion: Delaying pouch construction to when patients are in better health is suggested as a safer strategy over the long term. The surgical management of UC patients in the biologic era needs to be individualized, and a case-based multidisciplinary decision is critical for improved outcomes and a reduction of morbidity and mortality. |
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Keywords: | Colitis ulcerative surgery monoclonal antibodies postoperative complications |
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