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Updates in Surgery
Gilberto Poggioli
Editor
Ulcerative Colitis
Foreword by
Marco Montorsi
123
Editor
Gilberto Poggioli
Department of Medical and Surgical Sciences
University of Bologna
General Surgery Unit, Department of Digestive Diseases
S. Orsola-Malpighi Hospital
Bologna, 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 Surgery
ISBN 978-88-470-3976-6
DOI 10.1007/978-88-470-3977-3
Library of Congress Control Number: 2018948376
© Springer-Verlag Italia S.r.l. 2019
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or
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claims in published maps and institutional affiliations.
Cover design: eStudio Calamar S.L.
External publishing product development: Scienzaperta, Novate Milanese (Milan), Italy
Typesetting: Graphostudio, Milan, Italy
Printing and binding: Mariani Tipolitografia, Lissone (MB), Italy
ISBN 978-88-470-3977-3 (eBook)
This Springer imprint is published by Springer Nature
The registered company is Springer-Verlag Italia S.r.l.
The registered company address is Via Decembrio 28, I-20137 Milan
Foreword
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 Montorsi
President, Italian Society of Surgery
v
Preface
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.
vii
viii
Preface
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 Bologna, 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
Contents
1 History of Ulcerative Colitis .................................................................... 1
Gilberto Poggioli, Marco Salice, Nicola Renzi, and Massimo Campieri
Presentation and Natural Course of Ulcerative Colitis ........................ 17
2
Gilberto Poggioli and Nicola Renzi
3
Diagnosis of Ulcerative Colitis: the Role of Imaging Techniques ........ 29
Carla Serra, Chiara Praticò, and Alberta Cappelli
Diagnosis of Ulcerative Colitis: the Role of Endoscopy ........................ 45
4
Gilberto Poggioli, Massimo P. Di Simone, and Laura Vittori
5
Diagnosis of Ulcerative Colitis: Morphology and Histopathological
Characteristics
Antonietta D’Errico and Deborah Malvi
.......................................................................................... 61
Medical Treatment of Ulcerative Colitis: Does Traditional
6
Therapy Still Have a Role?
Fernando Rizzello, Marco Salice, Carlo Calabrese, Marta Mazza,
Andrea Calafiore, Lucia Calandrini, Hana Privitera Hrustemovic,
Massimo Campieri, and Paolo Gionchetti
Evolution of Surgical Treatment of Ulcerative Colitis .......................... 105
7
Gilberto Poggioli, Lorenzo Gentilini, Maurizio Coscia, Luca Boschi,
and Federica Ugolini
8
Surgical Treatment of Ulcerative Colitis: How Has the Timing
of Surgery Changed?
Gilberto Poggioli, Laura Vittori, Federico Ghignone,
Lorenzo Gentilini, and Maurizio Coscia
..................................................................... 93
............................................................................... 115
ix
x
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
Long-term Complications after Surgical Treatment
12
of Ulcerative Colitis
.................................................................................. 173
Gilberto Poggioli, Lorenzo Gentilini, Maurizio Coscia,
and Federica Ugolini
Management and Treatment of Fistulas after Surgical
13
Treatment of Ulcerative Colitis
............................................................... 195
Gilberto Poggioli, Laura Vittori, and Silvio Laureti
Contents
All web addresses have been checked and were correct at time of printing.
Contributors
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
xi
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