Clin Colon Rectal Surg 2010; 23(4): 248-258
DOI: 10.1055/s-0030-1268251
© Thieme Medical Publishers

Laparoscopic Surgery for Ulcerative Colitis

Luca Stocchi1
  • 1Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
Further Information

Publication History

Publication Date:
07 December 2010 (online)


Laparoscopic techniques have become increasingly used in the treatment of ulcerative colitis: in experienced hands, they are safe and feasible. Recovery advantages have not been consistently demonstrated and functional results have been comparable to open surgery. Other possible benefits and costs issues have also been inconsistent. Further investigation on the role of laparoscopic surgery for ulcerative colitis with larger populations and longer follow-up with a focus on recovery parameters, quality of life, and costs are needed.


  • 1 Truelove S C, Witts L J. Cortisone in ulcerative colitis; final report on a therapeutic trial.  BMJ. 1955;  2(4947) 1041-1048
  • 2 Hanauer S B. Inflammatory bowel disease.  N Engl J Med. 1996;  334(13) 841-848
  • 3 Selvasekar C R, Cima R R, Larson D W et al.. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis.  J Am Coll Surg. 2007;  204(5) 956-962 discussion 962-963
  • 4 Mor I J, Vogel J D, da Luz Moreira A, Shen B, Hammel J, Remzi F H. Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy.  Dis Colon Rectum. 2008;  51(8) 1202-1207 discussion 1207-1210
  • 5 Schluender S J, Ippoliti A, Dubinsky M et al.. Does infliximab influence surgical morbidity of ileal pouch-anal anastomosis in patients with ulcerative colitis?.  Dis Colon Rectum. 2007;  50(11) 1747-1753
  • 6 Kunitake H, Hodin R, Shellito P C, Sands B E, Korzenik J, Bordeianou L. Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications.  J Gastrointest Surg. 2008;  12(10) 1730-1736 discussion 1736-1737
  • 7 Ferrante M, D'Hoore A, Vermeire S et al.. Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis.  Inflamm Bowel Dis. 2009;  15(7) 1062-1070
  • 8 Coquet-Reinier B, Berdah S V, Grimaud J C et al.. Preoperative infliximab treatment and postoperative complications after laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis: a case-matched study.  Surg Endosc. 2010;  24(8) 1866-1871
  • 9 Ooi B S, Remzi F H, Fazio V W. Turnbull-Blowhole colostomy for toxic ulcerative colitis in pregnancy: report of two cases.  Dis Colon Rectum. 2003;  46(1) 111-115
  • 10 Dunker M S, Bemelman W A, Slors J F, van Hogezand R A, Ringers J, Gouma D J. Laparoscopic-assisted vs open colectomy for severe acute colitis in patients with inflammatory bowel disease (IBD): a retrospective study in 42 patients.  Surg Endosc. 2000;  14(10) 911-914
  • 11 Marcello P W, Milsom J W, Wong S K, Brady K, Goormastic M, Fazio V W. Laparoscopic total colectomy for acute colitis: a case-control study.  Dis Colon Rectum. 2001;  44(10) 1441-1445
  • 12 Seshadri P A, Poulin E C, Schlachta C M, Cadeddu M O, Mamazza J. Does a laparoscopic approach to total abdominal colectomy and proctocolectomy offer advantages?.  Surg Endosc. 2001;  15(8) 837-842
  • 13 Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y. Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients.  Surgery. 2007;  141(5) 640-644
  • 14 Ouaïssi M, Lefevre J H, Bretagnol F, Alves A, Valleur P, Panis Y. Laparoscopic 3-step restorative proctocolectomy: comparative study with open approach in 45 patients.  Surg Laparosc Endosc Percutan Tech. 2008;  18(4) 357-362
  • 15 Watanabe K, Funayama Y, Fukushima K, Shibata C, Takahashi K, Sasaki I. Hand-assisted laparoscopic vs. open subtotal colectomy for severe ulcerative colitis.  Dis Colon Rectum. 2009;  52(4) 640-645
  • 16 Telem D A, Vine A J, Swain G et al.. Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come.  Surg Endosc. 2010;  24(7) 1616-1620
  • 17 Maartense S, Dunker M S, Slors J F, Gouma D J, Bemelman W A. Restorative proctectomy after emergency laparoscopic colectomy for ulcerative colitis: a case-matched study.  Colorectal Dis. 2004;  6(4) 254-257
  • 18 Holubar S D, Larson D W, Dozois E J, Pattana-Arun J, Pemberton J H, Cima R R. Minimally invasive subtotal colectomy and ileal pouch-anal anastomosis for fulminant ulcerative colitis: a reasonable approach?.  Dis Colon Rectum. 2009;  52(2) 187-192
  • 19 McAllister I, Sagar P M, Brayshaw I, Gonsalves S, Williams G L. Laparoscopic restorative proctocolectomy with and without previous subtotal colectomy.  Colorectal Dis. 2009;  11(3) 296-301
  • 20 da Luz Moreira A, Kiran R P, Lavery I. Clinical outcomes of ileorectal anastomosis for ulcerative colitis.  Br J Surg. 2010;  97(1) 65-69
  • 21 Lefevre J H, Bretagnol F, Ouaïssi M, Taleb P, Alves A, Panis Y. Total laparoscopic ileal pouch-anal anastomosis: prospective series of 82 patients.  Surg Endosc. 2009;  23(1) 166-173
  • 22 Fichera A, Silvestri M T, Hurst R D, Rubin M A, Michelassi F. Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results.  J Gastrointest Surg. 2009;  13(3) 526-532
  • 23 Agha A, Moser C, Iesalnieks I, Piso P, Schlitt H J. Combination of hand-assisted and laparoscopic proctocolectomy (HALP): technical aspects, learning curve and early postoperative results.  Surg Endosc. 2008;  22(6) 1547-1552
  • 24 Marcello P W, Fleshman J W, Milsom J W et al.. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial.  Dis Colon Rectum. 2008;  51(6) 818-826 discussion 826-828
  • 25 Rivadeneira D E, Marcello P W, Roberts P L et al.. Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study.  Dis Colon Rectum. 2004;  47(8) 1371-1376
  • 26 Marcello P W, Milsom J W, Wong S K et al.. Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy.  Dis Colon Rectum. 2000;  43(5) 604-608
  • 27 Boller A M, Larson D W. Laparoscopic restorative proctocolectomy for ulcerative colitis.  J Gastrointest Surg. 2007;  11(1) 3-7
  • 28 Hasegawa S, Nomura A, Kawamura J et al.. Laparoscopic restorative total proctocolectomy with mucosal resection.  Dis Colon Rectum. 2007;  50(8) 1152-1156
  • 29 Bordeianou L, Hodin R. Total proctocolectomy with ileoanal J-pouch reconstruction utilizing the hand-assisted laparoscopic approach.  J Gastrointest Surg. 2009;  13(12) 2314-2320
  • 30 Benavente-Chenhalls L, Mathis K L, Dozois E J, Cima R R, Pemberton J H, Larson D W. Laparoscopic ileal pouch-anal anastomosis in patients with chronic ulcerative colitis and primary sclerosing cholangitis: a case-matched study.  Dis Colon Rectum. 2008;  51(5) 549-553
  • 31 Hochman D J, Pemberton J H. Hand-assisted laparoscopic total proctocolectomy and ileal pouch-anal anastomosis after liver transplant for primary sclerosing cholangitis.  Surg Laparosc Endosc Percutan Tech. 2007;  17(1) 56-57
  • 32 Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection.  Int J Colorectal Dis. 2008;  23(7) 703-707
  • 33 Araki Y, Ishibashi N, Ogata Y, Shirouzu K, Isomoto H. The usefulness of restorative laparoscopic-assisted total colectomy for ulcerative colitis.  Kurume Med J. 2001;  48(2) 99-103
  • 34 Hashimoto A, Funayama Y, Naito H et al.. Laparoscope-assisted versus conventional restorative proctocolectomy with rectal mucosectomy.  Surg Today. 2001;  31(3) 210-214
  • 35 Brown S R, Eu K W, Seow-Choen F. Consecutive series of laparoscopic-assisted vs. minilaparotomy restorative proctocolectomies.  Dis Colon Rectum. 2001;  44(3) 397-400
  • 36 Larson D W, Cima R R, Dozois E J et al.. Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience.  Ann Surg. 2006;  243(5) 667-670 discussion 670-672
  • 37 Kienle P, Z'graggen K, Schmidt J, Benner A, Weitz J, Büchler M W. Laparoscopic restorative proctocolectomy.  Br J Surg. 2005;  92(1) 88-93
  • 38 Zhang H, Hu S, Zhang G et al.. Laparoscopic versus open proctocolectomy with ileal pouch-anal anastomosis.  Minim Invasive Ther Allied Technol. 2007;  16(3) 187-191
  • 39 Heise C P, Kennedy G, Foley E F, Harms B A. Laparoscopic restorative proctocolectomy with ileal S-pouch.  Dis Colon Rectum. 2008;  51(12) 1790-1794
  • 40 Berdah S V, Mardion R B, Grimaud J C et al.. Mid-term functional outcome of laparoscopic restorative proctocolectomy: a prospective study of 40 consecutive cases.  J Laparoendosc Adv Surg Tech A. 2009;  19(4) 485-488
  • 41 El-Gazzaz G S, Kiran R P, Remzi F H, Hull T L, Geisler D P. Outcomes for case-matched laparoscopically assisted versus open restorative proctocolectomy.  Br J Surg. 2009;  96(5) 522-526
  • 42 Maartense S, Dunker M S, Slors J F et al.. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial.  Ann Surg. 2004;  240(6) 984-991 discussion 991-992
  • 43 Larson D W, Dozois E J, Piotrowicz K, Cima R R, Wolff B G, Young-Fadok T M. Laparoscopic-assisted vs. open ileal pouch-anal anastomosis: functional outcome in a case-matched series.  Dis Colon Rectum. 2005;  48(10) 1845-1850
  • 44 Dunker M S, Bemelman W A, Slors J F, van Duijvendijk P, Gouma D J. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study.  Dis Colon Rectum. 2001;  44(12) 1800-1807
  • 45 Larson D W, Davies M M, Dozois E J et al.. Sexual function, body image, and quality of life after laparoscopic and open ileal pouch-anal anastomosis.  Dis Colon Rectum. 2008;  51(4) 392-396
  • 46 Polle S W, Dunker M S, Slors J F et al.. Body image, cosmesis, quality of life, and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial.  Surg Endosc. 2007;  21(8) 1301-1307
  • 47 Dowson H M, Bong J J, Lovell D P, Worthington T R, Karanjia N D, Rockall T A. Reduced adhesion formation following laparoscopic versus open colorectal surgery.  Br J Surg. 2008;  95(7) 909-914
  • 48 Indar A A, Efron J E, Young-Fadok T M. Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions.  Surg Endosc. 2009;  23(1) 174-177
  • 49 Joyce M RHT, Geisler D P, Remzi F H et al.. Is laparoscopic surgery ileal pouch-anal anastomosis associated with fewer adhesions when compared with open surgery? (abstr).  Dis Colon Rectum. 2010;  53 609
  • 50 Duepree H J, Senagore A J, Delaney C P, Fazio V W. Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy.  J Am Coll Surg. 2003;  197(2) 177-181
  • 51 Andersen L P, Klein M, Gögenur I, Rosenberg J. Incisional hernia after open versus laparoscopic sigmoid resection.  Surg Endosc. 2008;  22(9) 2026-2029
  • 52 Gorgun E, Remzi F H, Goldberg J M et al.. Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: a study of 300 patients.  Surgery. 2004;  136(4) 795-803
  • 53 Antolovic D, Kienle P, Knaebel H P et al.. Totally laparoscopic versus conventional ileoanal pouch procedure—design of a single-centre, expertise based randomised controlled trial to compare the laparoscopic and conventional surgical approach in patients undergoing primary elective restorative proctocolectomy—LapConPouch-Trial.  BMC Surg. 2006;  6 13
  • 54 Holubar S D, Privitera A, Cima R R, Dozois E J, Pemberton J H, Larson D W. Minimally invasive total proctocolectomy with Brooke ileostomy for ulcerative colitis.  Inflamm Bowel Dis. 2009;  15(9) 1337-1342
  • 55 Larson D W, Dozois E, Sandborn W J, Cima R. Total laparoscopic proctocolectomy with Brooke ileostomy: a novel incisionless surgical treatment for patients with ulcerative colitis.  Surg Endosc. 2005;  19(9) 1284-1287

Luca StocchiM.D. 

Department of Colorectal Surgery, Cleveland Clinic

9500 Euclid Ave., Desk A31, Cleveland, OH 44195