The term inflammatory conditions of the colon indicates, principally, two distinct and particular nosological entities that are well-studied and adequately characterized: Ulcerative colitis and Crohn’s disease. These conditions present a number of common characteristics as well as differences. Both are chronic conditions that are mainly treated conservatively by gastroenterologists, while on many occasions they require surgical treatment while laparoscopic surgery is increasingly gaining momentum.
Ulcerative colitis is a disease of the colon mucosa, of unknown etiology with relapses and flares. It affects the colon causing ulcers and micro abscesses. It manifests with hemorrhagic diarrhea. However, skin, eye or liver function manifestations or other manifestations may be present as well. If not properly treated, it may result in the occurrence of toxic megacolon, an extensive dilation of the large intestine requiring immediate surgical treatment. Finally, ulcerative colitis is a predisposing factor for colon cancer. Diagnosis is achieved through endoscopy and histological examination, and conservative treatment is followed during flares of the disease. Ulcerative colitis is definitively treated with surgery. The procedure of choice is total colectomy (total removal of the colon) followed by ileorectal anastomosis with or without creation of a pouch, in two or three parts. It can be treated with laparoscopic surgery, despite the technical difficulties, since it offers a better surgical field. It is associated with lower blood loss, faster recovery and less postoperative pain.
Crohn’s disease occurring mostly at younger ages, presents flares and relapses, and may affect any part of the GI tract but most frequently the terminal ileum. Its clinical image includes diarrhea, pain, fatigue, and weight loss. The severe forms of the disease may present with stricture, occlusion, abscesses, perforation while extra-intestinal manifestations (appearing on the skin, the eyes, the joints, the liver, the biliaries, the skin). Diagnosis is based on endoscopy with biopsy and radiology tests. Conservative treatment aims at reducing the frequency and the severity of the disease flares and surgery is recommended for treating abscesses, fistulas and strictures with the implementation of specialized techniques but also for resecting the affected part of the intestine (mostly right colectomy). Laparoscopic colectomy is a safe and effective method for treating Crohn’s disease, offering at the same time all the advantages of a laparoscopic surgery together with better esthetic results addressing a chronic, although benign disease affecting younger ages.