Browsing by Author "Spinelli, A."

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Fistulizing Crohn's disease
(Mosby Inc., 2020) Lightner, A.L.; Ashburn, J.H.; Brar, M.S.; Carvello, M.; Chandrasinghe, P.; Van Overstraeten, A.D.B.; Fleshner, P.R.; Gallo, G.; Kotze, P.G.; Holubar, S.D.; Reza, L.M.; Spinelli, A.; Strong, S.A.; Tozer, P.J.; Truong, A.; Warusavitarne, J.; Yamamoto, T.; Zaghiyan, K.
No abstract available
Incidence, prevalence and trends in IBD
(CRC Press, 2018) Chandrasinghe, P.; Spinelli, A.; Warusavitarne, J.
The inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, are inflammatory conditions of unknown aetiology that affect the gastrointestinal tract. In Saudi Arabia, an increasing incidence of IBD has been registered, and a comparable disease progression has been recognised. Disease location is a significant factor associated with the long-term outcome in IBD. Extra-intestinal manifestations are pathologically and clinically important entities in IBD. Mortality due to IBD may be caused by complications of acute flares of the disease, long-term complication of the disease or surgical complications. Surgery is required in patients with IBD mainly for intestinal complications. The natural history of IBD is difficult to assess in today’s context, as a majority patients with symptoms will be undergoing some form of treatment. The downward trend may have been the result of more comprehensive surveillance programmes established in many high-volume IBD centres. IBDs are common chronic conditions, which place a significant burden on the individual and community.
Long-term function after transanal versus transabdominal ileal pouch-anal anastomosis for ulcerative colitis: a multicenter cohort study
(Wiely-Blackwell, 2019) Chandrasinghe, P.; Carvello, M.; Wasmann, K.; Tanis, P.; Warusavitarne, J.; Spinelli, A.; Bemelman, W.
AIM:The novel transanal approach to ileal pouch-anal anastomosis (ta-IPAA) provides better exposure with lower short-term morbidity in ulcerative colitis (UC). The aim of this study was to assess the long-term outcomes after ta-IPAA versus abdominal IPAA (abd-IPAA) in UC. METHOD:This is a multicentre cohort analysis between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. The primary end-point was CGQL (Cleveland Global Quality of Life) score at 12 months. RESULTS:374 patients (100 ta-IPAA vs 274 abd-IPAA) were included. Mean CGQL scores were comparable between the two groups (0.75 ± 0.11 vs 0.71 ± 0.14; respectively, P = 0.1). Quality of life (7.71 ± 1.17 vs 7.30 ± 1.46; P = 0.04) and energy level (7.16 ± 1.52 vs 6.66 ± 1.68; P = 0.03) were significantly better after ta-IPAA, while the quality of health item was comparable (7.68 ± 1.26 vs 7.64 ± 1.44; P = 0.9655). Stool frequencies (> 10/24 h:22% vs 21%; P = 1.0) and major incontinence rates (27% vs 26%; P = 0.89) were similar. Thirty-day morbidity rates (33% vs 41%; P = 0.2) and anastomotic leak rates were comparable (6% vs 13%; P = 0.09). CONCLUSION: This study, for the first time, provides evidence of comparable long-term functional outcome of ta-IPAA vs abd-IPAA for UC.
Long-term function after transanal vs. transabdominal ileal pouch-anal anastomosis for ulcerative colitis: a multi-centre cohort study
(Oxford University Press, 2019) Chandrasinghe, P.; Carvello, M.; Wasmann, K.; Tanis, P.; Warusavitarne, J.; Spinelli, A.; Bemelman, W.
BACKGROUND:The transanal approach has been introduced in ileal pouch-anal (IPAA) surgery to gain better exposure for the rectal dissection. It has been shown to be safe with lower morbidity than the trans-abdominal approach. The aim of this study was to compare functional outcome of transanal ileal pouch-anal anastomosis (ta-IPAA) with transabdominal (abd-IPAA) approach for ulcerative colitis (UC) using the Cleveland Global Quality of Life (CGQL). METHODS: This is a multi-centre cohort of consecutive patients undergoing abd-IPAA or ta-IPAA for UC prospectively registered in the databases of three tertiary referral institutions between March 2002 to September 2017. Patient characteristics, surgical details and postoperative outcomes were retrieved. The primary end-point was pouch function determined by CGQL score. The questionnaire was administered to all patients with a functioning pouch for 12 months. RESULTS: Ninety-nine patients with ta-IPAA were compared with 274 patients with abd-IPAA. A defunctioning stoma was created at the time of pouch construction in 46 (46%) patients undergoing ta-IPAA and in 130 (47%) patients with abd-IPAA (p = 0.90). Thirty-day postoperative complications according to Clavien-Dindo classification (p = 0.22) as well as anastomotic leak rates (13% vs. 6%), abd-IPAA and ta-IPAA, respectively, were comparable (p = 0.09). Time to stoma closure did not differ between the two groups (abd-IPAA- 6 ± 7 vs. ta-IPAA- 5 ± 4 months; p = 0.72). Twelve months CGQL score was obtained for 251 patients in the abd-IPAA group and for 97 in ta-IPAA cohort. The CGQL index was comparable between the two groups (0.72 ± 0.15 vs. 0.75 ± 0.12; p = 0.07). Quality of health and energy level components were statistically higher for ta-IPAA (7.30 ± 1.53 vs. 7.73 ± 1.19, p = 0.01; 6.68 ± 1.74 vs. 7.17 ± 1.54, p = 0.01) while no difference was found for quality of life item (7.63 ± 1.52 vs. 7.62 ± 1.30, p = 0.73). Pouch failure (including defunction and excision) was reported in 40 of 298 (12%) patients undergoing abd-IPAA and in 1 patient (1%) having ta-IPAA during the follow-up period. CONCLUSIONS: ta-IPAA produces functional result comparable to transabdominal approach at 12 months after surgery.
Risk factors for locally advanced cancer associated with ulcerative colitis: Results of a retrospective multicentric study in the era of biologics
(Elsevier, 2020) Rottoli, M.; Tanzanu, M.; Di Candido, F.; Colombo, F.; Frontali, A.; Chandrasinghe, P.C.; Pellino, G.; Frasson, M.; Warusavitarne, J.; Panis, Y.; Sampietro, G.M.; Spinelli, A.; Poggioli, G.
BACKGROUND: Patients affected by ulcerative colitis (UC) are more likely to develop colorectal cancer, and are often diagnosed with lymph node involvement (N+) at surgery. AIM: To identify the risk factors for N+ cancer in UC patients. METHODS: Patients undergoing surgery from 2001 to 2018 in six European tertiary centres were included. N+ patients were compared to the control group (N-) for clinical variables. The evaluation of risk factors for N+ was assessed using univariate and multivariable logistic regression analyses. RESULTS: A total of 130 patients were included. Median duration of disease was 21 years (1-52). Forty patients (30.8%) were N+ at surgery. Eighteen (13.8%) developed cancer within 10 years from the onset of UC. Younger age at surgery (Odds ratio -OR- 0.96, p = 0.042), left colon location (OR 2.44, p = 0.045) and the presence of stricture (OR 5.07, p = 0.002) were associated with N+. CONCLUSION: Location in the left colon, presence of strictures and younger age strongly correlated with a higher risk of N+ cancer, which could develop before the starting point of surveillance. Duration, extension and severity of disease were not associated with N+. These results should be considered in the evaluation of risk of advanced cancer in UC patients. KEYWORDS: Cancer; Lymph nodes; Ulcerative colitis.
SMAD7 shows a biphasic expression pattern during progression of ulcerative colitis-associated colorectal cancer
(Oxford University Press, 2019) Chandrasinghe, P.; Cereser, B.; Moorghen, M.; Spaggiari, P.; Maroli, A.; Del Bel Belluz, L.; Hart, A.; Spinelli, A.; Stebbing, J.; Warusavitarne, J.
BACKGROUND: Ulcerative colitis (UC) is an idiopathic inflammation of the intestine with an increased risk of developing colitis-associated cancer (CAC). Currently, clinical trials are underway aiming to inhibit SMAD7 to ameliorate inflammation. While the direct effect of depleting SMAD7, an inhibitory molecule in the transforming growth factor-β1 (TGFβ1) pathway, may be therapeutic in UC, its indirect effect on CAC development is largely unknown. TGFβ1 is known to enhance late stages of sporadic colorectal cancers (CRC), where SMAD7 is also elevated. Therefore, we hypothesise that removing inhibition of this pathway by depleting SMAD7 may also be detrimental for CAC. We therefore evaluated the expression of SMAD7 in the colonic epithelium during the inflammation associated neoplastic process to determine a possible role of SMAD7 in CAC. METHODS: The expression of SMAD7 protein and mRNA in colonic epithelia was assessed by immunohistochemistry (IHC) and in situ hybridisation (ISH),, respectively, in a cohort of 53 archival colon samples (17 CAC, 12 dysplastic, 12 inflammed, 12 non-neoplastic/non-inflammed) from patients who have undergone colectomies for UC and CAC. The expression within the epithelial cells was evaluated by both digital quantification and validated by blind scoring by a pathologist. Significant differences were tested with one-way ANOVA and Mann–Whitney U test. RESULTS: Cytoplasmic expression of SMAD7 protein is significantly higher in the inflammed epithelium compared with non-inflamed epithelium (p < 0.0001). Interestingly, a significant decrease of the same was detected in dysplasia (p = 0.01), although this group is characterised by a higher variability. SMAD7 levels are elevated in cancer compared with dysplasia, suggesting a biphasic expression (p = 0.009), which could be in part due to the different genetic composition. SMAD7 mRNA expression was not significantly different across different stages of CAC (p = 0.49). We hypothesise that the lack of correlation between mRNA and protein levels could be attributed to yet unknown post-transcriptional or post-translational regulations. CONCLUSIONS:In our cohort of UC affected colon tissues, SMAD7 demonstrated a biphasic expression pattern along the different stages of CAC with peaks during active inflammation and cancer. The increase in SMAD7 expression during neoplastic transformation, comparable to sporadic CRC, may be a protective response of the epithelium to inhibit the effect of TGFβ1. Although inhibiting SMAD7 as a therapy for UC may remit inflammation, we hypothesise it may exacerbate CAC due to further enhancement in TGFβ1 signalling. We envisage further mechanistic studies in vitro, in particular in organoids, could help in understanding the TGFβ superfamily pathway in CAC.
Technical variations and feasibility of transanal ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified across continents.
(Springer-Verlag, 2018) Zaghiyan, K.; Warusavitarne, J.; Spinelli, A.; Chandrasinghe, P.; Di Candido, F.; Fleshner, P.
PURPOSE: Initial reports of transanal ileal pouch-anal anastomosis (taIPAA) suggest safety and feasibility compared with transabdominal IPAA. The purpose of this study was to evaluate differences in technique and results of taIPAA in three centers performing taIPAA across two continents. METHODS: Prospective IPAA registries from three institutions in the US and Europe were queried for patients undergoing taIPAA. Demographic, preoperative, intraoperative, and postoperative data were compiled into a single database and evaluated. RESULTS: Sixty-two patients (median age 38 years; range 16-68 years, 43 (69%) male) underwent taIPAA in the three centers (USA 24, UK 23, Italy 15). Most patients had had a subtotal colectomy before taIPAA [n = 55 (89%)]. Median surgical time was 266 min (range 180-576 min) and blood loss 100 ml (range 10-500 ml). Technical variations across the three institutions included proctectomy plane of dissection (intramesorectal or total mesorectal excision plane), specimen extraction site (future ileostomy site vs. anus), ileo-anal anastomosis technique (stapled vs. hand sewn) and use of fluorescence angiography. Despite technical differences, anastomotic leak rates (5/62; 8%) and overall complications (18/62; 29%) were acceptable across the three centers. CONCLUSIONS: This is the first collaborative report showing safety and feasibility of taIPAA. Despite technical variations, outcomes are similar across centers. A large multi-institutional, international IPAA collaborative is needed to compare technical factors and outcomes.
Transanal ileal pouch-anal anastomosis for ulcerative colitis has comparable long-term functional outcomes to transabdominal approach: a multicentre comparative study
(Elsevier Science., 2020) Chandrasinghe, P.; Carvello, M.; Wasmann, K.; Foppa, C.; Tanis, P.; Perry-Woodford, Z.; Warusavitarne, J.; Spinelli, A.; Bemelman, W.
BACKGROUND:The transanal approach to ileal pouch-anal anastomosis (Ta-IPAA) provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis (UC). The aim of this study was to assess the long-term functional outcomes after Ta-IPAA versus transabdominal IPAA (Abd-IPAA) in UC.STUDY DESIGN:A multicentre cohort analysis was done between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL (Cleveland global quality of life) score at 12 months with a functioning pouch was considered the primary endpoint.RESULTS:A total of 374 patients (100 Ta-IPAA vs 274 Abd-IPAA) were included. Ta-IPAA demonstrated a comparable overall quality of life (CGQL score) to Abd-IPAA (0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p=0.1). Quality of life (7.71 ± 1.17 vs 7.30 ± 1.46; p=0.04) and energy level items (7.16 ± 1.52 vs 6.66 ± 1.68; p=0.03) were significantly better after Ta-IPAA, while the quality of health item was comparable (7.68 ± 1.26 vs 7.64 ± 1.44; p=0.96). Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies (>10/ 24 hrs:22% vs 21%; p=1.0) and the rate of single episode of major incontinence during the 12-month period (27% vs 26%; p=0.89) were similar. The differences in thirty-day morbidity rates (33% vs 41%; p=0.2) and the anastomotic leak rates were not significant (6% vs 13%; p=0.09). CONCLUSION AND RELEVANCE:This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.
Transanal minimal invasive proctectomy (TaMIP) for perineal Crohn’s disease; a multi-centre prospective cohort study
(Oxford University Press, 2019) Chandrasinghe, P.; Di Candido, F.; Warusavitarne, J.; Spinelli, A.
BACKGROUND: Transanal minimally invasive proctectomy (TaMIP) has some advantages particularly in relation to access to the deep pelvis. Key challenges faced with the TaMIP approach for proctectomy in Crohn’s disease are the diseased pelvis and inflamed, bulky mesorectum causing difficult planes. This study aims to assess the short-term outcomes and perineal wound complications following TaMIP for Crohn’s disease. METHODS: All patients undergoing TaMIP proctectomy between 2014 and 2018, at 2 tertiary care referral centres were prospectively evaluated. Thirty-day morbidity, operative details and perineal wound complications were analysed. RESULTS:A total of 33 patients (M 42%, age 38.5 years; range 26 to 77) have undergone TaMIP for Crohn’s disease. Surgeries were performed as double single port procedures with either complete mesorectal excision or close rectal dissection. The mean operative time was 120 min (range: 60–240) for the perineal procedure and 234 min (range: 140–279) for the total procedure. One case (3%) had to be converted to an open procedure due to difficult dissection and haemorrhage. Ninety per cent of the patients were ASA II and 54.5% underwent completion proctectomy while 45.5% had a panproctocolectomy as a single procedure. Four patients (12%; II 2, III 2) had complications which were Clavien-Dindo II and above. One patient had re-intervention for a pelvic collection while another patient had a ureteric injury. Vacuum dressing was used for primary wound closure in one patient. Major perineal wound dehiscence was seen in 6% (2 of 33) of the patients while one needed vacuum therapy. In long-term follow-up one patient developed an enterocutaneous fistula at the abdominal wound while 7 (21%) chronic perineal sinuses were reported. CONCLUSIONS:Perineal Crohn’s disease poses a challenge for transanal minimally invasive surgery due to the chronic inflammation and perineal sepsis. Transanal approach offers a safe and feasible option for perineal Crohn’s disease. The commonest complication following TaMIP is the development of a chronic perineal sinus and evaluation with laparoscopic and open techniques would be useful to ascertain if this rate is different.
Transanal minimally invasive proctectomy (TaMIP) in patients with Crohn’s disease: A cohort study from the TaTME international database
(Oxford University Press, 2018) Pellino, G.; Sahnan, K.; Penna, M.; Adegbola, S.; Chandrasinghe, P.; Hompes, R.; Spinelli, A.; Warusavitarne, J.; International TaTME Registry Collaborative
BACKGROUND :Perianal Crohn’s disease (pCD) is a debilitating condition and despite the advances of medical and surgical treatment, a proportion of patients eventually require proctectomy for severe and/or refractory pCD. TaTME has several advantages, particularly in patients with low rectal cancer, narrow pelvis, previous radiation and bulky prostate. Aim of this study is to assess the feasibility of transanal minimally invasive proctectomy (TaMIP) within the International TaTME registry. METHODS:The TaTME registry was interrogated from 2014 to 2017 for benign conditions. Data were collected across 11 international centres submitted for patients who received TaMIP, with or without TME, for pCD. RESULTS:Forty patients (mean age 42.6 ± 13.8 years) underwent TaMIP for pCD with a median total operative time of 202 ± 102 min for the abdominal phase and 126 ± 58 min for the perineal phase. The majority of patients were female (67.5%; 27 of 40), 80.0% had active IBD at the time of surgery and average duration of follow-up was 4.4 ± 5.8 months. The commonest approach to proctectomy was an intersphincteric APE (30.0%; 12 of 40), with over half of cases (52.5%; 21 of 40) undergoing total intersphincteric dissection. The median height of the pursestring was 4.4 ± 2.4 cm and the most common extraction site was transanal (37.5%; 15 of 40). Intact specimens were found in 21% (8 of 38 TME) and major defects in four cases. During the abdominal phase, 29% (9 of 31) cases were converted-to-open procedure (all strategic) and 20% (8 of 40) during the perineal phase. Peri-operative complications during perineal dissection were: bleeding (12.5%, 5 of 40), incorrect plane (15%, 6 of 40), issues with smoke extraction (12.5%; 5 of 40) and maintaining pneumopelvis (10.0%; 4 of 40). Rectal perforations occurred in two cases at a median of 4 ± 2.8 cm from the anal verge. There were no urethral injuries and blood loss was < 100 ml in 45.4% (15.33) in our cohort. The average length of stay was 6 ± 5 days with no post-operative mortalities. The majority of patients (75.0%; 30 of 40) had no complications. Two-thirds of patients had Clavien-Dindo grade II complications (60.0%; 6 of 40) and one patient had a grade III complication. Late morbidity (>1 month) was available for 23 patients and perineal wound complications were identified in over half of patients (56.5%). CONCLUSIONS: pCD causes perineal fibrosis and chronic sepsis, which can make proctectomy an extremely complex operation (particularly when associated with proctitis), thereby increasing the risk of complications. TaMIP offers a safe and feasible minimally invasive approach to this subset of patients. Outcomes from TaMIP need to be compared with current techniques in order to discern the future role and training requirements for this promising new technique.
Transanal minimally invasive proctectomy (TaMIP) in patients with inflammatory bowel diseases (IBD) within the TaTME international database
(Oxford University Press, 2018) Pellino, G.; Sahnan, K.; Penna, M.; Adegbola, S.; Chandrasinghe, P.; Spinelli, A.; Hompes, R.; Warusavitarne, J.; International TaTME Registry Collaborative
BACKGROUND : The necessity of proctectomy in IBD often represents refractory disease, with severe active/chronic inflammation, frequently in the context of immunosuppression. Minimally invasive techniques are currently being used as an option in the often challenging operations required. We aim to assess the feasibility and short-term outcomes of a transanal minimally invasive approach to proctectomy (TaMIP) in patients undergoing surgery for IBD within the TaTME registry. METHODS: The TaTME registry (secure online database), was interrogated from 2014 to 2017 for benign conditions. Data were collected across 11 international centres submitted for IBD patients. Patients with ulcerative colitis (UC) received proctectomy with or without Ta-IPAA, and patients with Crohn’s disease (CD) received TaMIP, with or without total mesorectal excision (TME), for perianal CD (pCD).RESULTS: In total, 174 patients with a median BMI of 25.6 ± 4.7 kg/m2 were entered into the database. The majority of patients (77%; 134 of 174) had UC and 79.9% (111 of 174) had a simultaneous laparoscopic or single-incision laparoscopic (SILS) approach to the abdomen. Active IBD featured in 63.8% (111 of 174) which was more prominent in the CD patients (80% vs. 59%, p = 0.015) and 19% (33 of 174) were on steroids at the time of surgery. The median total operative time was 249 ± 113 min (abdominal phase 206 ± 112 and perineal phase 133 ± 60 min). An incorrect plane was the most common problem encountered intra-operatively (10.3%; 18 of 174) followed by bleeding (9.2%; 16 of 174). There was an inadvertent rectal perforation rate of 5.6% (6 of 107). Over a fifth of abdominal procedures were converted (21.6%; 30 of 139) compared with 17 (9.8%) in the perineal phase. There were more perineal conversions in CD patients (20% vs. 6.7%, p = 0.028). A purse-string was used in 51.1% (81 of 174) at a median height of 3.8 ± 2 cm. Most anastomoses were created using a stapler (85.1%; 57 of 67) at median distance of 2.9 ± 1.5 cm from the anal verge. The median length of postoperative stay was 9 ± 6.5 days, which was longer in the UC patients (9 ± 7 days vs. 6 ± 5 days, p = 0.0079). There were no mortalities. Forty-four patients (25.3%) had a complication and seven (15.9%) of these (i.e. 4% of total cohort) had a grade III Clavien-Dindo complication (re-operation). Data on late morbidity (>1 month) were available in 92 patients and 15 of these patients (16.3%) had a wound breakdown. Two of these had a VAC dressing and three had re-operations. There was a trend towards more wound sinuses in CD (19% vs. 4.8%, p = 0.062). CONCLUSIONS:Our results demonstrate that the application of a transanal minimally invasive approach to proctectomy is a feasible option in IBD patients with a relatively low complication rate.
Transanal minimally invasive proctectomy with ileal pouch anal anastomosis (Ta-IPAA) in patients with ulcerative colitis: a cohort study from the TaTME international database
(Oxford University Press, 2018) Pellino, G.; Sahnan, K.; Penna, M.; Adegbola, S.; Chandrasinghe, P.C.; Spinelli, A.; Hompes, R.; Warusavitarne, J.; International TaTME Registry Collaborative
BACKGROUND:Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) can achieve excellent outcomes in terms of function and quality of life, for patients refractory to medical therapy for ulcerative colitis (UC). Minimally invasive approaches are gaining momentum and evolution of the transanal approach to rectal surgery has led to broadening its use, from total mesenteric excision (TME) in cancer, to include IPAA in ulcerative colitis. In this study, we analysed the short-term outcomes of transanal minimally invasive IPAA (Ta-IPAA) within the International TaTME registry.METHODS:The TaTME registry, a secure online database was interrogated from 2014 to 2017 for benign conditions. Data were collected across 11 international centres submitted for patients who received Ta-IPAA, with or without TME, for UC. RESULTS:Sixty-nine patients with a median age of 38.6 ± 12.2 years were entered into the database. The majority of patients were male (75.4%; 52/69) and had a median BMI of 24.4 ± 4 kg/m2. There were no smokers in our cohort. Over half of the patients (53.6; 37/69) had active IBD at the time of surgery and 12 patients were on steroids at the time of the surgery. A proctectomy in the TME plane was the most common approach (75.4%; 52/69), a close rectal dissection was chosen in 13 patients and in four patients the plane was not specified. A simultaneous abdominal/TaTME approach was performed in over two-thirds of cases (69.6%; 48/69) and most surgeons either used an SILS approach (46.4%; 32/69) or a laparoscopic approach (40.6%; 28/69). A pursestring was used by the majority (87%; 60/69) at a median height of 4 ± 1.6 cm. The majority of pouches were created using a stapler (85.1%; 57/69) at a median distance of 2.9 ± 1.5 cm from the anal verge. Median operative time was 311 ± 126 min. Under a quarter of abdominal operations were converted (24.6%; 14/57) compared with four cases (5.8%) in the perineal phase. The median length of postoperative stay was 10 ± 6 days and three patients had a re-operation. There were no mortalities. Three patients (4.3%) had an anastomotic leak and two patients (2.9%) had collections. Late morbidity (>1 month) was available in 31 patients and of these seven patients (22.6%) had a stricture. CONCLUSIONS: Transanal minimally invasive proctectomy with ileal pouch anal anastomosis is feasible and safe in patients with UC. It is also associated with relatively low rates of re-operation and anastomotic leakage.