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  • Review Article
  • Published:

Surgical management of IBD—from an open to a laparoscopic approach

Nature Reviews Gastroenterology & Hepatology volume 10, pages 297–306 (2013)Cite this article

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Abstract

Surgery is a key feature of IBD management. Up to 70% of patients with Crohn's disease and 35% of patients with ulcerative colitis will require surgery during the course of their disease. This Review provides an overview of IBD surgical management, focusing on the potential benefits and drawbacks of laparoscopy compared with open surgery. Emergency and elective indications for both laparoscopic and open surgery are detailed for patients with ulcerative colitis and Crohn's disease. Evidence-based comparative results of these surgical approaches are discussed, along with factors that influence patient outcomes. Upcoming new techniques for IBD surgical management, including single-port surgery, are also presented.

Key Points

  • Surgical management of Crohn's disease should not be considered curative; this approach is used to provide relief of symptoms, without jeopardizing bowel function

  • Laparoscopic surgery for small bowel non-penetrating Crohn's disease is associated with improved surgical outcomes compared with open surgery

  • A laparoscopic approach can be safely proposed to patients with complex Crohn's disease with penetrating or recurring behaviour

  • Laparoscopic surgery for severe acute colitis (SAC) is associated with a similar (or improved) short-term outcome compared with an open approach

  • Laparoscopic ileal pouch–anal procedures for ulcerative colitis are associated with improved short-term outcomes, as well as a reduced rate of long-term small-bowel obstruction and hernia, compared with an open approach

  • To date, no data are available regarding laparoscopic surgery for SAC complicated by perforation, haemorrhage or megacolon

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Authors and Affiliations

  1. Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, Clichy, 92110, France

    Léon Maggiori & Yves Panis

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  1. Léon Maggiori
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L. Maggiori and Y. Panis researched data for the article, substantially contributed to the discussion of content and wrote the article. Y. Panis also reviewed and edited the manuscript before submission.

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Correspondence to Yves Panis.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Studies comparing open and laparoscopic ileocolic resection for non-penetrating Crohn's disease (DOC 83 kb)

Supplementary Table 2

Studies comparing open and laparoscopic abdominal colectomy for severe acute colitis (DOC 48 kb)

Supplementary Table 3

Studies comparing open and laparoscopic ileal-pouch anal procedure for ulcerative colitis (DOC 62 kb)

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Maggiori, L., Panis, Y. Surgical management of IBD—from an open to a laparoscopic approach. Nat Rev Gastroenterol Hepatol 10, 297–306 (2013). https://doi.org/10.1038/nrgastro.2013.30

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