Improving surgical techniques in IBD
Despite the increasing number of medical options, a significant part of IBD patients will need surgery at some point. Therefore our group is undertaking efforts to develop new surgical techniques, further improving outcome in IBD patients.
Repeated bowel resections are quite common in Crohn’s disease (CD) patients. Those patients are at increased risk for intestinal failure. Maximal bowel conserving strategies should therefore be used in CD patients. We have recently demonstrated the safety of side-to-side isoperistaltic strictureplasties, the so-called Michelassi strictureplasties, in the surgical treatment of primary stenotic terminal ileal disease. This technique has the advantage of treating the stricture while avoiding bowel resection. Moreover, (partial) mucosal healing and some degree of bowel wall healing have been observed, however, the mechanisms of healing and the degree of functional recovery is not understood. Prospective research is undertaken in order to describe possible mechanisms of healing and functional recovery. The impact of microbiota and wound healing macrophages are studied, while functional recovery is investigated by observing intestinal motility of the treated segment and bile salt reabsorption.
About 20% of all ulcerative colitis (UC) patients will ultimately undergo surgery for intractable or complicated disease. The treatment of choice is the ileal pouch-anal anastomosis which has already been described back in the late 70’s. This technique has not undergone significant modifications, except the introduction of laparoscopy, which has significantly changed surgical outcome in UC patients. Our team is developing techniques in order to further decrease invasiveness in pouch surgery. Therefore, single port laparoscopic and transanal techniques are used. The team is about to report its initial experience with transanal IPAA surgery (ta-IPAA) in UC patients. Further research will focus on surgical and functional outcome, investigating the impact of these recent techniques on patients’ outcome.