Subtotal colectomy in ulcerative colitis—long term considerations for the rectal stump

• 作者: Orla Hennessy Laurence Egan Myles Joyce
• 来源期刊: 世界胃肠外科杂志:英文版(电子版)
• 学科: 医学
• 关键词: Stump Ulcerative colitis SURVEILLANCE ENDOSCOPY RECTAL SCREENING
• 年，卷（期）: 2021,（2）
• 页码范围: 198-209
• 页数: 12页
• 分类号: R57

摘要

BACKGROUND The initial operation of choice in many patients presenting as an emergency with ulcerative colitis is a subtotal colectomy with end ileostomy.A percentage of patients do not proceed to completion proctectomy with ileal pouch anal anastomosis.AIM To review the existing literature in relation to the significant long-term complications associated with the rectal stump,to provide an overview of options for the surgical management of remnant rectum and anal canal and to form a consolidated guideline on endoscopic screening recommendations in this cohort.METHODS A systematic review was carried out in accordance with PRISMA guidelines for papers containing recommendations for endoscopy surveillance in rectal remnants in ulcerative colitis.A secondary narrative review was carried out exploring the medical and surgical management options for the retained rectum.RESULTS For rectal stump surveillance guidelines,20%recommended an interval of 6 mo to a year,50%recommended yearly surveillance 10%recommended 2 yearly surveillance and the remaining 30%recommended risk stratification of patients and different screening intervals based on this.All studies agreed surveillance should be carried out via endoscopy and biopsy.Increased vigilance is needed in endoscopy in these patients.Literature review revealed a number of options for surgical management of the remnant rectum.CONCLUSION The retained rectal stump needs to be surveyed endoscopically according to risk stratification.Great care must be taken to avoid rectal perforation and pelvic sepsis at time of endoscopy.If completion proctectomy is indicated the authors favour removal of the anal canal using an intersphincteric dissection technique.