Updates in Surgery

Gilberto Poggioli Editor

Ulcerative Colitis

Foreword byMarco Montorsi

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EditorGilberto Poggioli Department of Medical and Surgical SciencesUniversity of BolognaGeneral Surgery Unit, Department of Digestive DiseasesS. Orsola-Malpighi HospitalBologna, Italy

The publication and the distribution of this volume have been supported by the Italian Society of Surgery

ISSN 2280-9848 ISSN 2281-0854 (electronic)Updates in SurgeryISBN 978-88-470-3976-6 ISBN 978-88-470-3977-3 (eBook)

DOI 10.1007/978-88-470-3977-3

Library of Congress Control Number: 2018948376

© Springer-Verlag Italia S.r.l. 2019

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Foreword

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The spirit of the Italian Society of Surgery’s Biennial Reports, established almost 25 years ago and one of its most important editorial activities, has always been to deal with highly relevant topics characterized by important diagnostic and therapeutic developments, assigned to recognized experts representing consolidated national surgical schools.

This is also the case of the present monograph on ulcerative colitis, addressed for the first time in this series: the Society’s Executive Board has decided to assign the topic to Prof. Gilberto Poggioli in representation of the glorious School of Bologna.

After the 2009 monograph on the treatment of Crohn’s Disease by Prof. Roberto Tersigni, the other major chapter of inflammatory bowel diseases – namely, ulcerative colitis – is now presented.

With the qualified contribution of colleagues from the University of Bologna and the S. Orsola-Malpighi Hospital, Prof. Poggioli has divided this complex area into clear and well-structured chapters that will help readers find their way and locate effective answers to the numerous clinical questions that this disease still poses today.

Great space has also been devoted to the more exquisitely surgical aspects of both technique and indication, without neglecting the great emerging field of minimally invasive methods.

Although the current trend is to progressively concentrate the management of this condition in referral centers offering all areas of expertise and able to maintain high volumes of activity, I am sure that all Italian surgeons will find great interest and frequent consultation of this work on which I congratulate all the authors on behalf of the whole Society.

Milan, September 2018 Marco MontorsiPresident, Italian Society of Surgery

The biennial report on ulcerative colitis which the Italian Society of Surgery (SIC) entrusted to me represents an honor as well as a tribute to the surgeons of the University of Bologna.

Exactly sixty years later, a chief of surgery at the University of Bologna is invited to speak on ulcerative colitis at the SIC congress. In fact, it was Gaetano Placitelli who first spoke about the systematic treatment of this disease at the SIC Congress in Genoa in 1958. Two years later, his fellows, Leonardo Possati and Antonello Franchini, published an awesome text (La colite ulcerosa, Bologna, 1960) which, for the first time in Italy, exhaustively discussed the disease from the etiopathogenetic as well as from the clinical, surgical and anatomopathological points of view.

Many years have passed since 1958; however, the school that Gaetano Placitelli founded has always considered inflammatory bowel diseases to be a scientific, didactic and patient-oriented topic. Knowledge regarding this topic has grown and experience has increased but, ever since 1958, Bologna has created what today we tend to call multidisciplinary teams. Under the direction of Professors Giuseppe Labò and Luigi Barbara and then Giorgio Assuero Lanfranchi, an osmosis between medical and surgical groups originated which has brought many scientific milestones to Bologna. The structural turning point arrived, however, with Prof. Massimo Campieri who, after having spent a long period of time in Oxford under the mythical Sydney Truelove, brought to Bologna this method, not only of working, but of reasoning in a joint teamwise fashion. Then, in 1981, my Maestro, Giuseppe Gozzetti who, together with Luigi Barbara and Massimo Campieri, put together a group of which I was a part directly from the beginning. Already in the 1980s, this group was characterized by the impressive number (first in Italy) of operations carried out for ulcerative colitis, in particular the ileoanal-pouch anastomosis, only a few years after the technique had been proposed in London at St. Mark’s Hospital by Sir Alan Parks and John Nicholls.

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Preface

Prefaceviii

All this, together with internships at the Cleveland Clinic and the Lahey Clinic, led to close friendships and international collaboration which, in turn, led to the first congress “New Trends in Pelvic Pouch Procedures” held in Bologna in 1989 in collaboration with the Cleveland and Mayo Clinics. It was the first occasion, not only for evaluating surgical techniques and complications, possible technical variants and future problems which the new type of surgery could involve, but, for the first time, to discuss the pathophysiology of ileoanal anastomosis, evaluating not only the anatomical changes, but also the quality of life as well as the physiological, morphological and functional modifications which derive from the surgery.

The rest is recent history and keeps up with the experiences of the largest world centers which are expert in this sector, bringing many of us to act as tutors in other Italian centers and to be a part of the drawing up of new guidelines of many scientific societies regarding the medical and surgical therapy for ulcerative colitis.

Therefore, I take the occasion of presenting this book as a tribute to Bolo-gna, to its Alma Mater Studiorum University, to its most important hospital, Policlinico S. Orsola-Malpighi, and to the colleagues who, in the past forty years, have dedicated their energy, passion and competence to improving and increasingly understanding the behavior, varieties, diagnosis and therapy of ulcerative colitis, a disease which is on the increase in the Western world.

Bologna, September 2018 Gilberto Poggioli

1 History of Ulcerative Colitis .................................................................... 1 Gilberto Poggioli, Marco Salice, Nicola Renzi, and Massimo Campieri

2 Presentation and Natural Course of Ulcerative Colitis ........................ 17 Gilberto Poggioli and Nicola Renzi

3 Diagnosis of Ulcerative Colitis: the Role of Imaging Techniques ........ 29 Carla Serra, Chiara Praticò, and Alberta Cappelli

4 Diagnosis of Ulcerative Colitis: the Role of Endoscopy ........................ 45 Gilberto Poggioli, Massimo P. Di Simone, and Laura Vittori

5 Diagnosis of Ulcerative Colitis: Morphology and Histopathological Characteristics .......................................................................................... 61 Antonietta D’Errico and Deborah Malvi

6 Medical Treatment of Ulcerative Colitis: Does Traditional Therapy Still Have a Role? ..................................................................... 93 Fernando Rizzello, Marco Salice, Carlo Calabrese, Marta Mazza, Andrea Calafiore, Lucia Calandrini, Hana Privitera Hrustemovic, Massimo Campieri, and Paolo Gionchetti

7 Evolution of Surgical Treatment of Ulcerative Colitis .......................... 105 Gilberto Poggioli, Lorenzo Gentilini, Maurizio Coscia, Luca Boschi, and Federica Ugolini

8 Surgical Treatment of Ulcerative Colitis: How Has the Timing of Surgery Changed? ............................................................................... 115 Gilberto Poggioli, Laura Vittori, Federico Ghignone, Lorenzo Gentilini, and Maurizio Coscia

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Contents

9 Surgical Treatment of Ulcerative Colitis: Indications and Techniques ......................................................................................... 123 Gilberto Poggioli, Lorenzo Gentilini, Maurizio Coscia, Luca Boschi, and Federica Ugolini

10 Surgical Treatment of Ulcerative Colitis: Laparoscopy and New Minimally Invasive Techniques .............................................. 139 Gilberto Poggioli and Matteo Rottoli

11 Results and Quality of Life after Surgical Treatment of Ulcerative Colitis .................................................................................. 155 Gilberto Poggioli, Lorenzo Gentilini, Maurizio Coscia, and Federica Ugolini

12 Long-term Complications after Surgical Treatment of Ulcerative Colitis .................................................................................. 173 Gilberto Poggioli, Lorenzo Gentilini, Maurizio Coscia, and Federica Ugolini

13 Management and Treatment of Fistulas after Surgical Treatment of Ulcerative Colitis ............................................................... 195 Gilberto Poggioli, Laura Vittori, and Silvio Laureti

All web addresses have been checked and were correct at time of printing.

Contentsx

Contributors

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Luca Boschi General Surgery Unit, Department of Digestive Diseases, S. Orsola-Malpighi Hospital, Bologna, Italy

Carlo Calabrese Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Andrea Calafiore Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Lucia Calandrini Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Massimo Campieri Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Alberta Cappelli Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy

Maurizio Coscia General Surgery Unit, Department of Digestive Diseases, S. Orsola-Malpighi Hospital, Bologna, Italy

Antonietta D’Errico Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Massimo P. Di Simone Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Lorenzo Gentilini General Surgery Unit, Department of Digestive Diseases, S. Orsola-Malpighi Hospital, Bologna, Italy

Federico Ghignone General Surgery Unit, Department of Digestive Diseases, S. Orsola-Malpighi Hospital, Bologna, Italy

Paolo Gionchetti Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

xii Contributors

Silvio Laureti Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Deborah Malvi Pathology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy

Marta Mazza Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Gilberto Poggioli Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Chiara Praticò Interventional Ultrasound Unit, Department of Organ Failure and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy

Hana Privitera Hrustemovic Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Nicola Renzi Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Fernando Rizzello Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Matteo Rottoli Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Marco Salice Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Carla Serra Interventional Ultrasound Unit, Department of Organ Failure and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy

Federica Ugolini General Surgery Unit, Department of Digestive Diseases, S. Orsola-Malpighi Hospital, Bologna, Italy

Laura Vittori General Surgery Unit, Department of Digestive Diseases, S. Orsola-Malpighi Hospital, Bologna, Italy