title: State-of-the-art surgical approaches to the treatment of medically refractory ulcerative colitis.
abstract: BACKGROUND
  Management of medically refractory ulcerative collitis (UC) is a significant challenge to the surgeon. Operative morbidity is high and the potential for mortality remains.
  
  
  CONCLUSIONS
  Medical therapies have the potential to meaningfully improve the patient, or may dangerously delay and complicate surgery. Operative planning must appropriately address the patient's acuity without losing sight of the patient's long-term need for definitive surgical care and adequate functional outcome. State-of-the-art treatment hinges on prompt recognition of patients with acute severe UC, multidisciplinary coordination of medical therapy, and mature surgical judgment. Biologic therapies and minimally invasive surgical technologies represent the vanguard in UC. However, state-of-the-art treatment of acute severe UC is not employment of the newest drug or technology, but early performance of standard of care surgery, ileal pouch anal anastomosis, for every eligible patient. As the range of therapies available for UC continues to expand, the challenge for the surgeon is incorporating these new drugs and devices without losing sight of the standard of care.
authors.affiliation: The Crohn's and Colitis Center and the Department of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, ACC 460, Boston, MA, 02114, USA, lbordeianou@partners.org.
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
authors.forename: Lillias
authors.initials: L
authors.lastname: Maguire
mesh_terms: D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D039021:Colonic Pouches; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D010348:Patient Care Team; D016737:Proctocolectomy, Restorative; D012720:Severity of Illness Index; D013997:Time Factors