SURGICAL TREATMENT OF ULCERATIVE COLITIS (LITERATURE REVIEW)

Abstract

This article provides an extensive analysis of the evolution of minimally invasive colorectal surgery and modern approaches to the surgical management of ulcerative colitis (UC). Beginning with the first laparoscopic-assisted right hemicolectomy performed by Jacobs et al. in 1990, the authors highlight the substantial progress in video-endoscopic technologies while emphasizing persistent limitations, including the lack of tactile feedback, loss of three-dimensional perception, and technical challenges in obese patients, those with prior abdominal surgery, or those with locally advanced disease. The introduction of hand-assisted laparoscopic surgery (HALS) has expanded the applicability of minimally invasive techniques by improving intraoperative control, reducing conversion rates, and shortening operative time.The paper reviews the current landscape of UC surgery, noting that despite advances in medical therapy, up to 50% of patients require surgical intervention. The major factors contributing to poor outcomes include delayed surgery, absence of unified criteria for medical treatment resistance, high systemic toxicity, and severe metabolic disturbances. Persistent difficulties involve the absence of a universally accepted “gold standard” for restorative surgery in UC, the high rate of functional complications after IPAA, and ongoing debate regarding optimal reconstructive strategies.Modern trends in minimally invasive surgery including total laparoscopic IPAA, transanal approaches (ta-IPAA), and robotic techniques are examined. Literature data demonstrate benefits such as improved quality of life, reduced adhesion formation, better fertility outcomes, and fewer postoperative complications. The review concludes that optimization of UC treatment requires refined patient selection, improved perioperative management, and integration of innovative technologies while maintaining strict surgical and oncological principles.