SELECTION OF SURGICAL STRATEGY FOR COMPLICATIONS OF ULCERATIVE COLITIS
Keywords:
ulcerative colitis, surgery, laparoscopyAbstract
This article presents an expanded analysis of surgical strategies for managing complicated forms of ulcerative colitis (UC). Modern approaches to assessing resistance to conservative therapy, diagnostic criteria for steroid resistance, and morphological features of inflammation and their correlation with clinical manifestations are thoroughly described. A comparative evaluation of major surgical interventions—including subtotal colectomy, ileorectal anastomosis (IRA), ileal pouch–anal anastomosis (IPAA), as well as minimally invasive techniques such as laparoscopy and HALS—is provided. Special attention is given to postoperative management, correction of enteral insufficiency, prevention of septic complications, and methods for improving long-term outcomes. The necessity of early identification of surgical indications and an individualized approach to the choice of operative tactics is substantiated to reduce mortality and improve the quality of life in patients with severe UC.
References
Hueting W.E., Buskens E. Surgical management of ulcerative colitis: unresolved challenges and modern approaches. Colorectal Dis., 2022; 24(3): 275–289.
Keswani R.N., Cohen R.D. Ulcerative colitis: epidemiology, natural history and surgical indications. Gastroenterology Clinics, 2022; 51(1): 45–60.
Ruf G., Holubar S.D. Indications for surgery in ulcerative colitis and outcomes after colectomy. Int. J. Colorectal Dis., 2022; 37(5): 1123–1134.
Maskin S.S. Современные малоинвазивные технологии в хирургии толстой кишки. Хирургия, 2019; №7: 12–18.
Фролов С.А. Лапароскопические операции с ручной ассистенцией (HALS) при воспалительных заболеваниях кишечника. Колопроктология, 2020; №4: 33–41.
Юсупов И.А. Эндолимфатическая антибиотикотерапия при воспалительных заболеваниях кишечника. Вестник хирургии Узбекистана, 2023; №2: 55–64.
Shen B., Fazio V.W. Functional outcomes after ileal pouch–anal anastomosis. Ann Surg., 2022; 276(4): 603–612.
Bach S.P., Mortensen N.J. Surgical options and long-term outcomes in ulcerative colitis. J. Gastrointest. Surg., 2021; 25(2): 301–313.
Mortier P.E., Leroy J., et al. Role of rectal stump preservation in ulcerative colitis surgery. Tech Coloproctol., 2022; 26(3): 215–224.
Kanshin N.N. Выбор уровня резекции прямой кишки при НЯК. Российский журнал гастроэнтерологии, 2020; 30(5): 47–54.
Holubar S.D., Larson D.W. Minimally invasive subtotal colectomy for fulminant colitis. Dis Colon Rectum., 2009; 52: 187–192.
Marcello P.W., Milsom J.W. Laparoscopic restorative proctocolectomy: comparison with open surgery. Dis Colon Rectum., 2000; 43: 604–612.
Maartense S., Dunker M.S. HALS versus open restorative proctocolectomy: randomized trial. Ann Surg., 2004; 240: 984–991.
Zhu P., Xing C. Hand-assisted laparoscopic restorative proctocolectomy for ulcerative colitis.
J. Minimal Access Surg., 2017; 13(4): 256–260.
Agha A., Iesalnieks I. Hand-assisted laparoscopic proctocolectomy: early postoperative results. Surg Endosc., 2008; 22(6): 1547–1552.
Lefevre J.H. Total laparoscopic IPAA: prospective series of 82 patients. Surg Endosc., 2009; 23: 166–173.
Baek S.J. et al. Outcomes in patients undergoing minimally invasive IPAA. Tech Coloproctol., 2016; 20: 369–374.
Hull T.L., Joyce M.R. Adhesions after laparoscopic vs. open IPAA surgery. Br J Surg., 2012; 99(2): 270–275.
Flynn J., Kong J.C. Robotic versus laparoscopic techniques in colorectal surgery. Int J Colorectal Dis., 2021; 36: 1621–1631.
Jayne D., Pigazzi A. Robotic-assisted vs. laparoscopic surgery for rectal cancer: ROLARR Trial. JAMA., 2017; 318: 1569–1580.
