title: Surgical Principles in the Treatment of Ulcerative Colitis.
abstract: BACKGROUND
  The primary treatment of ulcerative colitis (UC) is conservative; surgical intervention is carried out in the case of therapy-refractory situation, imminent or malignant transformation, or complications. Surgery for UC should be indicated by interdisciplinary means. Despite the development of drug therapy - in particular the introduction of biologics -, a surgical intervention becomes necessary in a relevant proportion of patients with UC throughout lifetime.
  
  
  METHODS
  A selective literature search was conducted, taking into account the current studies, reviews, meta-analyses, and guidelines. PubMed served as a database. The present work gives an overview of the surgical options, outcome as well as peri- and postoperative management for patients with UC.
  
  
  RESULTS
  Approximately 20% of patients with UC will require surgery during the course of their disease. The rate of colectomy after a disease duration of 10 years is at approximately 16%. Unlike Crohn's disease, UC is principally surgically curable since it is naturally limited to the colon and rectum. Restorative proctocolectomy with an ileal pouch-anal anastomosis represents the surgical treatment of choice. Large studies show a postoperative complication rate of around 30% and a low mortality of 0.1% for this procedure. Chronic pouchitis is one of the main factors limiting the surgical success of curing UC. Despite a high postoperative complication rate, there is a long-term pouch success rate of >90% after 10 and 20 years of follow-up.
  
  
  CONCLUSIONS
  A close cooperation between the various disciplines in the pre- and postoperative setting is essential for an optimal outcome of patients with UC. Despite a 30% rate of early postoperative complications, normal quality of life can ultimately be reached in more than 90% of patients in experienced centers.
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Kühn
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Klar
keywords: IPAA; Pouchitis; Surgery; Ulcerative colitis