Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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

  • 108 Accesses

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.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240(2):205–213

  2. 2.

    Holte K, Kehlet H (2000) Postoperative ileus: a preventable event. BJS 87(11):1480–1493

  3. 3.

    S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE), 2. komplett überarbeitete Auflage“, S. 238.

  4. 4.

    Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel J-F (2017) Ulcerative colitis. Lancet 389(10,080):1756–1770

  5. 5.

    Burisch J, Munkholm P (2015) The epidemiology of inflammatory bowel disease. Scand J Gastroenterol 50(8):942–951

  6. 6.

    Katz JA (2000) Medical and surgical management of severe colitis. Semin Gastrointest Dis 11(1):18–32

  7. 7.

    de Silva S (2011) Postoperative complications and mortality following colectomy for ulcerative colitis. Clin Gastroenterol Hepatol 9(11):972–980

  8. 8.

    Ordás I (2018) Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: nationwide multicenter study of the GETECCU ENEIDA registry. Am J Gastroenterol 113(7):1009–1016

  9. 9.

    Singh S (2015) Postoperative mortality among patients with inflammatory bowel diseases: a systematic review and meta-analysis of population-based studies. Gastroenterology 149(4):928–937

  10. 10.

    Selvasekar CR (2007) Effect of Infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 204(5):956–962

  11. 11.

    Yang Z, Wu Q, Wu K, Fan D (2010) Meta-analysis: pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis. Aliment Pharmacol Ther 31(4):486–492

  12. 12.

    Mor I, Vogel J, Moreira A d L, Shen B, Hammel J, Remzi F (2008) Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum 51(8):1202–1210

  13. 13.

    Uchino M (2019) Associations between multiple immunosuppressive treatments before surgery and surgical morbidity in patients with ulcerative colitis during the era of biologics. Int J Color Dis

  14. 14.

    Golda T, Kreisler E, Mercader C, Frago R, Trenti L, Biondo S (2014) Emergency surgery for perforated diverticulitis in the immunosuppressed patient. Colorectal Dis Off J Assoc Coloproctology G B Irel 16(9):723–731

  15. 15.

    Trickett JP, Tilney HS, Gudgeon AM, Mellor SG, Edwards DP (2005) Management of the rectal stump after emergency sub-total colectomy: which surgical option is associated with the lowest morbidity? Color Dis 7(5):519–522

  16. 16.

    McKee RF, Keenan RA, Munro A (1995) Colectomy for acute colitis: is it safe to close the rectal stump? Int J Color Dis, 10 (4):222–224

  17. 17.

    Wøjdemann M, Wettergren A, Hartvigsen A, Myrhøj T, Svendsen LB, Bülow S (1995) Closure of rectal stump after colectomy for acute colitis. Int J Color Dis 10(4):197–199

  18. 18.

    Lawson EH, Hall BL, Ko CY (2013) Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives. JAMA Surg 148(9):849–858

  19. 19.

    Crabtree TD, Pelletier SJ, Antevil JL, Gleason TG, Pruett TL, Sawyer RG (2001) Cohort study of fever and leukocytosis as diagnostic and prognostic indicators in infected surgical patients. World J Surg 25(6):739–744

  20. 20.

    Bernstein CN, Ng SC, Lakatos PL, Moum B, Loftus EV (2013) A review of mortality and surgery in ulcerative colitis milestones of the seriousness of the disease. Inflamm Bowel Dis 19(9):2001–2010

  21. 21.

    Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L (2008) Perioperative treatment with Infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg 12(10):1730–1737

  22. 22.

    Brady RRW, Collie MHS, Ho GT, Bartolo DCC, Wilson RG, Dunlop MG (2008) Outcomes of the rectal remnant following colectomy for ulcerative colitis. Color Dis 10(2):144–150

  23. 23.

    Gu J, Stocchi L, Remzi F, Kiran RP (2013) Intraperitoneal or subcutaneous: does location of the (colo)rectal stump influence outcomes after laparoscopic total abdominal colectomy for ulcerative colitis? Dis Colon Rectum 56(5):615–621

  24. 24.

    Vernero M, Boano V, Ribaldone DG, Pellicano R, Astegiano M (2019) Oral iron supplementation with Feralgine® in inflammatory bowel disease: a retrospective observational study. Minerva Gastroenterol Dietol 65(3): 200-203

  25. 25.

    Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM (2015) Meta-analysis of the association between preoperative anaemia and mortality after surgery. BJS 102(11):1314–1324

  26. 26.

    Tan K-K, Ravindran P, Young CJ, Solomon MJ (2014) The extent of inflammation is a predictor for pouch-related complications in ileal pouches in patients with ulcerative or indeterminate colitis. Color Dis 16(8):620–625

  27. 27.

    Woźniak M, Barańska M, Małecka-Panas E, Talar-Wojnarowska R (2019) The prevalence, characteristics, and determinants of anaemia in newly diagnosed patients with inflammatory bowel disease, Przegla̜d Gastroenterol. 14(1):39–47

  28. 28.

    Heuschen UA (2002) Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis. Ann Surg 235(2):207

  29. 29.

    Lightner AL, Loftus EV, Raffals LE, Kenna NPM (2019) Vedolizumab in the perioperative management of inflammatory bowel disease. Curr Drug Targets [Online]. Verfügbar unter: http://www.eurekaselect.com/170942/article. [Zugegriffen: 18-Apr-2019]

  30. 30.

    Marcello P, Milsom J, Wong S, Brady K, Goormastic M, Fazio V (2001) Laparoscopic total colectomy for acute colitis: a case-control study. Dis Colon Rectum 44(10):1441–1445

  31. 31.

    Messenger DE, Mihailovic D, MacRae HM, O’Connor BI, Victor JC, McLeod RS (2014) Subtotal colectomy in severe ulcerative and Crohn’s colitis: what benefit does the laparoscopic approach confer? Dis Colon Rectum 57(12):1349–1357

  32. 32.

    Zerhouni S, Kirsch R, Bakonyi A, O’Connor B, Huang H, Cohen Z (2015) Severity of inflammation as a risk factor for ileo-anal anastomotic leak after a pouch procedure in ulcerative colitis. Int J Color Dis 30(10):1375–1380

  33. 33.

    Lightner AL (2017) Postoperative outcomes in Vedolizumab-treated patients undergoing abdominal operations for inflammatory bowel disease. J Crohns Colitis 11(2):185–190

  34. 34.

    Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y (2007) Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery 141(5):640–644

Download references

Author information

Correspondence to C. Schineis.

Ethics declarations

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

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Ulcerative colitis
  • Colectomy
  • Rectal stump leakage
  • Postoperative complications