Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colon. According to the literature, some thirty percent of UC patients may require a subtotal colectomy and ileostomy due to failure of medical treatment, acute toxic colitis or dysplasia/cancer diagnosis. Some patients choose to get continence restored with either an ileorectal anastomosis (IRA) or an ileal pouch-anal anastomosis (IPAA). Worldwide most surgeons prefer an IPAA to an IRA, despite reports of pouchitis, impaired fertility and fecundity. Fear of recurring proctitis and fear of rectal cancer in the remaining rectum is contributing to the choice of an IPAA. Little is known regarding the outcomes of IRA compared with IPAA in UC patients. We aimed to investigate the anorectal function, quality of life (QoL), risk of failure and rectal cancer in patients with UC restored with IRA and IPAA respectively. Methods: Data about all Inflammatory bowel disease (IBD) patients was obtained from the Swedish National Patient Register (NPR) between 1964-2014 and in one study from the Linköping University Hospital medical records 2006-2012. Patients who developed cancer were identified from the Swedish National Cancer Register. We investigated the risk of cancer and inflammation, functional outcome and failure as well as the quality of life for IRA and IPAA patients. Investigation of risk for cancer in IRA and IPAA compared with the background population was performed using survival analytic techniques: uni-and multivariate regression, Kaplan Meier curves and standardized incidence ratio. Results: Twelve percent (7,889 /63,795) of UC patients required colectomy according to the NPR. The relative risk for rectal cancer among patients with an IRA was increased (SIR 8.7). However, the absolute risk was 1.8% after a mean follow up of 8.6 years and the cumulative risk 10- and 20-years after IRA was 1.6% and 5.6%, respectively. Risk factors for rectal cancer were primary sclerosing cholangitis in patients with an IRA (hazard ratio 6.12), and severe dysplasia or cancer of the colon prior to subtotal colectomy in patients with a diverted rectum in place (hazard ratio 3.67). Regarding IPAA, the relative risk to develop rectal cancer was (SIR 0.4) compared with the background population and the absolute risk was only 0.06% after a mean of 12.2 years of follow up. Among patients operated at the Linköping University Hospital: IRA patients reported better overall continence according to the Öresland score with in median3 (IQR 2–5) for IRA (n=38) and 10 (IQR 5–15) for IPAA (n=39, p<0.001). There were no major differences regarding the QoL. According to the NPR, after a median follow up of 12.4 years failure occurred in 265(32%) out of 1112 patients, of which 76 were secondarily reconstructed with an IPAA. Failure of the IPAA occurred in 103 (6%) patients with primary and in 6 (8%) patients after secondary IPAA (log-rank p=0.38). Conclusion: IRA is a safe restorative procedure for selected UC patients. Patients should be aware of the annual postoperative endoscopic evaluation with biopsies as well as the need to the use of local anti-inflammatory preparations. However, IRA should not be offered for UC patients with an associated primary sclerosing cholangitis diagnosis due to the increased risk to develop rectal cancer in their rectal mucosa. In such case, IPAA is probably the treatment of choice.

This book provides a concise, yet comprehensive overview of cancer risks in patients with inflammatory bowel disease (IBD), as well as the screening modalities used to reduce these risks. Each chapter presents a major malignancy that patients with IBD are at risk from, stemming from the disease itself or from the medications used to treat the disease. Malignancies covered include colorectal cancer, skin cancer, lymphoma, and other cancers. Cancer risk and screening with current and emerging drug therapies are also discussed. Written by experts in the field, Cancer Screening in Inflammatory Bowel Disease: A Guide to Risk Management and Techniques is a valuable resource for gastroenterologists, colorectal surgeons, and primary care physicians who treat and manage patients with inflammatory bowel disease.

This book provides a guide to the management of patients with Crohn’s disease and ulcerative colitis. The indications for surgery within inflammatory bowel disease are covered, as well as new biologic medications and the effects they have on the immune system. Details on how these drugs should be managed to avoid complications and ensure patient safety are also included. Mastery of IBD Surgery sets out to cover surgical responses to inflammatory bowel disease from a multidisciplinary perspective and aims to help all surgeons and medical professionals working in this area. This book is relevant to colorectal surgeons, gastrointestinal surgeons, and gastroenterologists.

Interventional Inflammatory Bowel Diseases: Endoscopic Management and Treatment of Complications covers the preparation, principle, techniques, and damage control of complications in endoscopic therapy, providing the ultimate guidance in endoscopic management of IBD. With contributions from a panel of international leading experts in the field, perspectives are included from GI pathologists, GI radiologists, gastroenterologists, advanced endoscopists, IBD specialists and colorectal surgeons. Recommendations from experts are also included within each chapter. By bridging medical and surgical treatment modalities for IBD, this is the perfect reference for GI researchers, medical students, therapeutic GI endoscopists, IBD specialists, surgeons and advanced health care providers. - Incorporates state-of-the-art of research in the area of therapeutic endoscopy in Crohn's Disease and Ulcerative Colitis - Makes the connection between the understanding of the complex nature and disease course of IBD with corresponding advanced endoscopic procedures - Explores endoscopic treatment as the missing link between medical and surgical treatment for complex Crohn's Disease and Ulcerative Colitis - Contains access to videos demonstrating important procedural concepts

Reconstructive Colorectal and Anal Surgery presents a didactic discussion of complex colonic, rectal, anal, and perineal problems which require reoperative surgery. The book provides a very practical description of the management towards these problems including preoperative investigation, postoperative follow-up and detailed operative approach. The text is aimed at being relatively didactic with an algorithm approach to these complicated cases using operative photographs and composite explanatory line drawings which are complemented by ‘how-to’ guides in all cases describing the operative technical tips and pitfalls from experienced world-renowned commentators. Given the rapid change in techniques over the last 10 years newer procedures will be incorporated. This book will be essential reading for all colorectal surgeons and trainees, general surgeons and trainees, gynecologists as well as specialist nurses in the OR room.

This issue of Surgical Clinics of North America focuses on Inflammatory Bowel Disease and is edited by Dr. Sean Langenfeld. Articles will include: IBD presentation and diagnosis; Endoscopy in IBD; Preoperative considerations in IBD; Postoperative Considerations in IBD; IBD and cancer/dysplasia; Elective abdominal surgery for IBD; Abdominal emergencies in IBD; Anorectal Crohn’s disease; Other surgeries in IBD patients; Pediatric inflammatory bowel disease; Pouch complications; Genetic and environmental considerations for IBD; IBD and short bowel syndrome; Medical Management of IBD; and more!