Surgery of Inflammatory Bowel Diseases

Chronic inflammatory bowel diseases are represented by ulcerative colitis (UC) and Crohn's disease (CD). The cause of these diseases remains unknown and appears to be due to the combination of genetic and environmental factors that interact with the immune response and consequent inflammatory response. Chronic inflammation of the mucosa produces tissue damage that produces deep and extensive ulcerations. CD tends to involve the small intestine but also the colon can be affected, and the extent of the disease is variable while ulcerative colitis affects only the colon for a variable extent for which distal colitis is distinguished if it affects the rectum and the sigma and pancolitis when the entire colon is affected. Surgical therapy of chronic IBD is now considered an integral part of the therapeutic path and no longer as the last option. The evolution of surgical and anaesthetic techniques has made it possible to significantly reduce surgical complications, hospitalization times, inability to work life, functional sequelae on the gastrointestinal tract and consequently the impact on the quality of life of patients as amply demonstrated in numerous studies also carried out at our centre. The numerous types of intervention currently available and the accurate study of the disease both with radiological and endoscopic techniques of the latest generation together with the experience acquired at our centre over many years of activity and in constant comparison with the most accredited world centres allow us to implement targeted treatment for each individual case. In addition, the multidisciplinary approach to the patient allows constant collaboration with gastroenterologist specialists for an accurate planning of post-operative checks and the continuation of therapy aimed at preventing relapse according to the protocols currently recommended by international guidelines.

Surgical Options in Crohn's Disease

1. Strictureplasty: it is a plastic of enlargement of an intestinal stenosis without resection and therefore allows the saving of the involved intestinal tract.

2. The resection involves the removal of the intestinal tract affected by the disease with reconstruction of the intestinal transit by re-joining the intestinal stumps called anastomosis.

3. Colectomy: in the case of involvement of the colon, it is possible to perform a segmental resection or more and more of the colon up to the total colectomy if the rectum is spared from the disease by reconstructing the intestinal transit by means of ileo-rectum anastomosis.

4. In the presence of involvement of the rectum in some cases it is necessary to associate the proctectomy (removal of the rectum and anus) and the preparation of a permanent terminal ileostomy.

5. Surgery for anal abscesses and fistulas: the presence of disease at the level of the anus determines the formation of abscesses and / or fistulas that often require multiple interventions aimed at drainage and subsequently for definitive treatment by means of repairs with a mucous flap or interposition of muscle flaps in the most complex cases of rectovaginal fistula.

Surgical Options in Ulcerative Colitis

1. Proctocolectomy (removal of the colon and rectum) with permanent ileostomy: it is the operation traditionally performed in ulcerative colitis resistant to medical or complicated therapy and which involves the demolition of the colon and rectum with the externalization of the terminal ileum through the abdominal wall of the ileum and application of a device for collecting intestinal contents to the peristomal skin.

2. Restorative proctocolectomy also known as ileo-anal anastomosis with ileal pouch, this intervention, introduced more recently, involves the removal of the colon and rectum, however the canalization is maintained naturally by building an ileal reservoir that allows to avoid permanent ileostomy.


Our research mostly focuses on:

  1. Quality of life after surgery for IBD
  2. Molecular mechanisms in fibrosis in CD
  3. Immune surveillance mechanisms in UC-related carcinogenesis
  4. Surgical management of CD and UC



Eva Andreuzzi, Albina Fejza, Maurizio Polano, Evelina Poletto, Lucrezia Camicia, Greta Carobolante, Giulia Tarticchio, Federico Todaro, Emma Di Carlo, Melania Scarpa, Marco Scarpa, Alice Paulitti, Alessandra Capuano, Vincenzo Canzonieri, Stefania Maiero, Mara Fornasarig, Renato Cannizzaro, Roberto Doliana, Alfonso Colombatti, Paola Spessotto Maurizio Mongiat. Colorectal cancer development is affectedby the ECM molecule EMILIN-2 hingingon macrophage polarization via the TLR-4/MyD88 pathway. J Exp Clin Cancer Res (2022) 41:60

Angriman I, Colangelo A, Mescoli C,Fassan M, D’Incà R, Savarino E,Pucciarelli S, Bardini R, Ruffolo C, Scarpa M (2022) Validation of thePadova Prognostic Score for Colitis inPredicting Long-Term Outcome AfterRestorative Proctocolectomy.Front. Surg. 9:911044.doi: 10.3389/fsurg.2022.911044   

Angriman I, Buzzi G, Giorato E, et al. Crohn’s Disease-Related Stoma Complications and Their Impact on Postsurgical Course March 2022 Digestive Surgery 39(2-3) DOI: 10.1159/000524036

Angriman I, Tomassi M, Ruffolo C, Bordignon G, Saadeh L, Gruppo M, Pucciarelli S, Bardini R and Scarpa M (2022) Impact on Quality of Life ofSeton Placing in Perianal Crohn’s Disease. Front. Surg. 8:806497.doi: 10.3389/fsurg.2021.806497   

Laura Tasson, Fabiana Zingone, Brigida Barberio, Romina Valentini, Pamela Ballotta, Alexander C. Ford, Marco Scarpa, Imerio Angriman, Matteo Fassan, Edoardo Savarino. Sarcopenia, severe anxietyand increased C‑reactive proteinare associated with severe fatigue in patients with inflammatorybowel diseases. Scientific Reports | (2021) 11:15251 |


BIRD 2019 from the University of Padova to Imerio Angriman for the project “Molecular predictors of fibrosis in CD”

People involved:

Prof. Pucciarelli Salvatore, MD (Full Professor)
Prof. Imerio Angriman, MD (Associate Professor)

Group Member

Ruffolo Cesare, MD(Faculty)
Scarpa Marco, MD (Faculty)