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Colectomy with ileostomy for severe ulcerative colitis-postoperative complications and risk factors

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

In the era of biological therapy of ulcerative colitis (UC), surgical treatment frequently consists of colectomy, end ileostomy, and rectal stump closure before patients go on towards restorative proctocolectomy. We aimed to evaluate possible risk factors for the occurrence of postoperative complications and investigate those after initial colectomy in these patients.

Methods

Retrospective analysis of 180 patients (76 female, 104 male) undergoing colectomy for UC with formation of a rectal stump and terminal ileostomy between March 2008 and March 2018 at Charité University Hospital Berlin, Campus Benjamin Franklin. A panel of possible postoperative complications was established, patient history was screened, and postoperative complications were analyzed using the Clavien Dindo Classification.

Results

Postoperative complication rate was 27.7%. Mortality was 0.5%. Postoperative ileus occurred in 15.3% and rectal stump leakage in 14.8%. Complications were categorized as Clavien Dindo 3 in 80%. Risk factors for surgical complications after multivariate analysis were ASA classification (p = 0.004), preoperative anemia (Hemoglobin < 8 mg/dl) (p = 0.025), use of immunosuppressants (p = 0.003), more than two cardiovascular diseases (p = 0.016), and peritonitis (p = 0.000). Reoperation rate of patients with surgical complications was 27.7%.

Conclusion

Colectomy in high-risk UC patients is associated with significant morbidity. However, most of the surgical complications can be treated conservatively. Overall mortality is low. Patient-related risk factors are associated with postoperative complications. Optimizing these risk factors or earlier indication for surgery in the course of UC may help to reduce morbidity of this procedure.

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Authors and Affiliations

  1. Department of General, Visceral and Vascular Surgery, Charité University Hospital Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

    C. Schineis, K. S. Lehmann, J. C. Lauscher, K. Beyer, L. Hartmann, C. E. Degro, F. N. Loch, F. Speichinger, M. E. Kreis & C. Kamphues

  2. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

    G. A. Margonis

  3. Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany

    J. Michel

Authors
  1. C. Schineis
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  2. K. S. Lehmann
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  4. K. Beyer
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  7. J. Michel
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  8. C. E. Degro
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  11. M. E. Kreis
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Correspondence to C. Schineis.

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The Ethics committee of the Charité University Hospital Berlin (EA4/098/18) approved the study protocol.

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The authors declare that they have no conflict of interest.

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Schineis, C., Lehmann, K.S., Lauscher, J.C. et al. Colectomy with ileostomy for severe ulcerative colitis-postoperative complications and risk factors. Int J Colorectal Dis 35, 387–394 (2020). https://doi.org/10.1007/s00384-019-03494-w

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  • DOI: https://doi.org/10.1007/s00384-019-03494-w

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