- Author
-
M.E. Stellingwerf
- Title
- Surgery in Inflammatory Bowel Disease
- Subtitle
- A different point of view
- Supervisors
-
W.A. Bemelman
G.R.A.M. D'Haens - Co-supervisors
-
C.J. Buskens
- Award date
- 18 September 2020
- Number of pages
- 275
- ISBN
- 9789463808989
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
This thesis describes multiple surgical treatment options in patients with ulcerative colitis (UC) and perianal Crohn’s disease (CD).
An appendectomy is suggested to have a beneficial effect on UC, however, some recently published data reported an increased risk of colorectal cancer (CRC).
Part I confirms that a higher proportion of colectomies after appendectomy in UC is undertaken for CRC, but less for active colitis. We found an 84% decrease in colectomies and a delay in surgery. Furthermore, an appendectomy resulted in a clinical response in 46%, and 25% were in endoscopic remission after 4 years. Since the colon is longer in situ, the risk of CRC remains, which emphasises the importance of endoscopic surveillance.
Part II describes the results after restorative proctocolectomy and ileal pouch-anal anastomosis. Our research demonstrated that both techniques of double-end ileosigmoidostomy and end ileostomy with closed rectal stump are safe and effective. With respect to small bowel obstruction, the modified 2-stage IPAA seems the safest. In case of anastomotic leakage, long-term pouch function can be preserved with endo-sponge assisted early surgical closure.
Part III evaluates treatment options for high perianal fistulas in CD. We found that the knotless SuperSeton is a feasible novel technique which significantly improves fistula related quality of life. Definitive closure of the perianal fistulas can be achieved by the endorectal advancement flap and ligation of the intersphincteric fistula tract with comparable success and recurrence rates. Finally, the different treatment options were head-to-head compared in the randomised PISA-trial, which showed inferior outcomes for chronic seton drainage. - Persistent Identifier
- https://hdl.handle.net/11245.1/31faee31-6ad8-4bfc-a319-525a48588a1a
- Downloads
-
Thesis (complete)
Front matter
General introduction and outline of the thesis
Chapter 1: The risk of colectomy and colorectal cancer after appendectomy in patients with ulcerative colitis: a systematic review and meta-analysis
Chapter 2: A nationwide database study on colectomy and colorectal cancer in ulcerative colitis: what is the role of appendectomy?
Chapter 3: Prospective cohort study of appendectomy for treatment of therapy-refractory ulcerative colitis
Chapter 4: Histological remission of ulcerative colitis in four colonic resection specimens after therapeutic appendectomy
Chapter 5: Management of rectal stump during laparoscopic subtotal colectomy for inflammatory bowel disease: a comparative cohort study from six referral centres
Chapter 6: Risk factors for small bowel obstruction after laparoscopic ileal pouch-anal anastomosis for inflammatory bowel disease: a multivariate analysis in four expert centres in Europe
Chapter 7: Endo-sponge assisted early surgical closure of ileal pouch-anal anastomotic leakage preserves long-term function: a cohort study
Chapter 8: The role of the defaecating pouchogram in the assessment of evacuation difficulty after restorative proctocolectomy and pouch-anal anastomosis
Chapter 9: Knotless seton for perianal fistulas: feasibility and quality of life
Chapter 10: Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn’s high perianal fistulas
Chapter 11: Ligation of the intersphincteric fistula tract and endorectal advancement flap for high perianal fistulas in Crohn’s disease: a retrospective cohort study
Chapter 12: Treatment of perianal fistulas in Crohn’s disease, seton versus anti-TNF versus surgical closure following anti-TNF (PISA): a randomized controlled trial
Summary, general discussion and future perspectives
Nederlandse samenvatting; List of contributing authors; List of publications; PhD portfolio; Dankwoord; About the author
- Supplementary materials
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