Skip to main content

Advertisement

SpringerLink
Log in

A contemporary series of surgical outcomes following subtotal colectomy and/or completion proctectomy for management of inflammatory bowel disease

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

The main indications for emergency subtotal colectomy (SC) include management of toxic colitis, refractory haemorrhage and/or perforation. Alternatively, elective surgery is performed for those refractory to medical therapy or with evidence of multifocal dysplasia. Overall, the annual incidence of SC has fallen since the introduction of biologic therapies and we aimed to review our current practices.

Methods

A retrospective review of inflammatory bowel disease (IBD) patients undergoing subtotal colectomy between 2013 and 2020 was performed. Medical records, operative notes, discharge summaries, histopathology reports and other supporting documents were reviewed. Indication for surgery, management of the rectum (i.e. maintenance of rectal stump, progression to completion proctectomy or IPAA formation) associated morbidity (Clavien-Dindo classification) and length of hospital stay were examined.

Results

Fifty-six IBD patients underwent a subtotal colectomy. Twenty-five patients (UC 14, Crohn’s 11) had an elective procedure, and 31 patients (UC 19 Crohn’s 12) had an emergency/semi-urgent procedure. Interestingly, 80% (n = 25) of the emergency cohort and 68% (n = 17) of the elective cohort had a laparoscopic resection. Major morbidity (Clavien-Dindo > 2) was higher among the emergency group (39% vs. 24%). Deep surgical site infection was the commonest morbidity (13%) in the emergency group, while superficial surgical site infection was commonest in the elective cohort (20%). Overall, there was no difference in surgical re-intervention rate (13% vs 12%), and there were no perioperative mortalities. Median post-operative length of stay was shorter in the elective cohort (9 versus 13 days).

Conclusion

A significant proportion of IBD patients still require semi-urgent/emergency colectomy, which is associated with considerable length of stay and morbidity. The results of our study provide real-world outcomes to help counsel patients on expected outcomes.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lamb CA, Kennedy NA, Raine T et al (2021) British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 68(Suppl 3): 70(4):1s1-s106. https://doi.org/10.1136/gutjnl-2019-318484

  2. Hendrickson BA, Gokhale R, Cho JH (2002) Clinical aspects and pathophysiology of inflammatory bowel disease. Clin Microbiol Rev 15(1):79–94. https://doi.org/10.1128/CMR.15.1.79-94.2002

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ronnblom A, Holmström T, Tanghöj H et al (2016) Low colectomy rate five years after diagnosis of ulcerative colitis. Results from a prospective population-based cohort in Sweden (ICURE) diagnosed during 2005–2009. Scand J Gastroenterol 51:1339–44

  4. Brown SR, Fearnhead NS, Faiz OD et al (2018) The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease. Colorectal Dis 8:3–117. https://doi.org/10.1111/codi.14448 (PMID: 30508274)

    Article  Google Scholar 

  5. Cima RR (2010) Timing and indications for colectomy in chronic ulcerative colitis: Surgical consideration. Dig Dis. ;28(3):501–7. https://doi.org/10.1159/000320409. Epub 2010 Sep 30. PMID: 20926879

  6. Narula N, Marshall JK, Colombel JF et al (2016) Systematic review and meta-analysis: infliximab or cyclosporine as rescue therapy in patients with severe ulcerative colitis refractory to steroids. Am J Gastroenterol 4:477–491. https://doi.org/10.1038/ajg.2016.7

    Article  CAS  Google Scholar 

  7. Munie S, Hyman N, Osler T (2013) Fate of the rectal stump after subtotal colectomy for ulcerative colitis in the era of ileal pouch–anal anastomosis. JAMA Surg 148(5):408–411. https://doi.org/10.1001/jamasurg.2013.177

    Article  PubMed  Google Scholar 

  8. Hermand H, Lefèvre JH, Shields C et al (2021) Postoperative diagnostic revision for Crohn disease after subtotal colectomy for inflammatory bowel disease. Int J Colorectal Dis 36:709–715. https://doi.org/10.1007/s00384-020-03783-9

    Article  PubMed  Google Scholar 

  9. Hennessy O, Egan L, Joyce M (2021) Subtotal colectomy in ulcerative colitis-long term considerations for the rectal stump. World J Gastrointest Surg 13(2):198–209. https://doi.org/10.4240/wjgs.v13.i2.198

    Article  PubMed  PubMed Central  Google Scholar 

  10. IBD Registry Ltd (2021) IBD Registry-transition from IBD Audit to IBD Registry, Available at: https://ibdregistry.org.uk/audit-to-registry/ (Accessed: 21/8/21)

  11. Roses RE, Rombeau JL (2008) Recent trends in the surgical management of inflammatory bowel disease. World J Gastroenterol 14(3):408–412. https://doi.org/10.3748/wjg.14.408

    Article  PubMed  PubMed Central  Google Scholar 

  12. Atreya R, Neurath MF, Siegmund B (2020)  Personalizing treatment in IBD: hype or reality in 2020? Can we predict response to anti-TNF?. Front Med (Lausanne) 7:517. https://doi.org/10.3389/fmed.2020.00517

  13. Cesarini M, Collins GS, Rönnblom A et al (2017) Predicting the individual risk of acute severe colitis at diagnosis. J Crohns Colitis 11(3):335–341. https://doi.org/10.1093/ecco-jcc/jjw159

    Article  PubMed  Google Scholar 

  14. Parray FQ, Wani ML, Malik AA et al (2012) Ulcerative colitis: a challenge to surgeons. Int j preventive med 3(11):749–763

  15. Baker DM, Lee MJ, Jones GL et al (2017) The informational needs and preferences of patients considering surgery for ulcerative colitis: results of a qualitative study. Inflamm Bowel Dis 19;24(1):179–190. https://doi.org/10.1093/ibd/izx026

  16. Burns EM, Poulton T, Deputy M et al (2020) An audit of process and outcome for emergency colectomy in England and Wales. Colorectal Dis 22:2133–2139. https://doi.org/10.1111/codi.15367

    Article  CAS  PubMed  Google Scholar 

  17. Øresland T, Bemelman WA, Sampietro GM et al (2015) European Crohn’s and Colitis Organisation (ECCO). European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis 9(1):4–25. https://doi.org/10.1016/j.crohns.2014.08.012

  18. Zangenberg MS, Horesh N, Kopylov U et al (2017) Preoperative optimization of patients with inflammatory bowel disease undergoing gastrointestinal surgery: a systematic review. Int J Colorectal Dis 32(12):1663–1676. https://doi.org/10.1007/s00384-017-2915-4

    Article  PubMed  Google Scholar 

  19. Kedia S, Ahuja V, Tandon R (2014) Management of acute severe ulcerative colitis. World journal of gastrointestinal pathophysiology 5(4):579–588. https://doi.org/10.4291/wjgp.v5.i4.579

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ausch C, Madoff RD, Gnant M et al (2006) Aetiology and surgical management of toxic megacolon. Colorectal Dis 8(3):195–201. https://doi.org/10.1111/j.1463-1318.2005.00887.x (PMID: 16466559)

    Article  CAS  PubMed  Google Scholar 

  21. Binderow SR, Wexner SD (1994) Current surgical therapy for mucosal ulcerative colitis. Dis Col Rectum 37:610–24

  22. Heppell J, Farkouh E, Dubé S et al (1986) Toxic megacolon. An analysis of 70 cases. Dis Colon Rectum. 29(12):789–92. https://doi.org/10.1007/BF02555345. PMID: 3792159

  23. Wong DJ, Roth EM, Feuerstein JD et al (2019) Surgery in the age of biologics. Gastroenterology Report 7(2):77–90. https://doi.org/10.1093/gastro/goz004

    Article  PubMed  PubMed Central  Google Scholar 

  24. Leowardi C, Hinz U, Tariverdian M et al (2010) Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 395:49–56

    Article  PubMed  Google Scholar 

  25. Berndtsson I, Lindholm E, Oresland T et al (2007) Long-term outcome after ileal pouch-anal anastomosis: function and health-related quality of life. Dis Colon Rectum 50:1545–1552

    Article  PubMed  Google Scholar 

  26. Chang S, Shen B, Remzi F (2017) When not to pouch: important considerations for patient selection for ileal pouch-anal anastomosis. Gastroenterol Hepatol (N Y) 13(8):466–475

    Google Scholar 

  27. Fazio VW, Kiran RP, Remzi FH et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685

    Article  PubMed  Google Scholar 

  28. Die J, Ocaña J, Abadía P, García JC et al (2020) Experience, complications and prognostic factors of the ileoanal pouch in ulcerative colitis: an observational study. Cir Esp 98:64–71

    Article  PubMed  Google Scholar 

  29. Fazio VW, Tekkis PP, Remzi F et al (2003) Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 238(4):605–617. https://doi.org/10.1097/01.sla.0000090940.39838.6a

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ng KS, Gonsalves SJ, Sagar PM (2019) Ileal-anal pouches A review of its history, indications, and complications. World J Gastroenterol 25(31):4320–4342. https://doi.org/10.3748/wjg.v25.i31.4320

    Article  PubMed  PubMed Central  Google Scholar 

  31. Burns EM, Bottle A, Aylin P et al (2011) (2011) Volume analysis of outcome following restorative proctocolectomy. Br J Surg 98(3):408–417. https://doi.org/10.1002/bjs.7312

    Article  CAS  PubMed  Google Scholar 

  32. Ten Hove JR, Jonathan MK, Bogaerts M, et al (2019) Malignant and nonmalignant complications of the rectal stump in patients with inflammatory bowel disease. Inflamm Bowel Dis 25(2):377–384. https://doi.org/10.1093/ibd/izy253

    Article  PubMed  Google Scholar 

  33. Stocchi L (2010) Laparoscopic surgery for ulcerative colitis. Clinics in colon and rectal surg 23(4):248–58. https://doi.org/10.1055/s-0030-1268251

  34. Neumann PA, Rijcken E (2016) Minimally invasive surgery for inflammatory bowel disease: review of current developments and future perspectives. World J Gastrointest Pharmacol Ther 7(2):217–226. https://doi.org/10.4292/wjgpt.v7.i2.217

    Article  PubMed  PubMed Central  Google Scholar 

  35. Killeen S, Devaney A, Mannion M et al (2015) Omental pedicle flaps following proctectomy: a systematic review. Colorectal Dis 15(11):634–645. https://doi.org/10.1111/codi.12394

    Article  Google Scholar 

  36. Li W, Stocchi L, Elagili F et al (2017) Healing of the perineal wound after proctectomy in Crohn’s disease patients: only preoperative perineal sepsis predicts poor outcome. Tech Coloproctol 21(9):715–720. https://doi.org/10.1007/s10151-017-1695-8

    Article  CAS  PubMed  Google Scholar 

  37. Derikx LAAP, Nissen LHC, Smits LJT et al (2016) Risk of neoplasia after colectomy in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 14(6):798-806.e20. https://doi.org/10.1016/j.cgh.2015.08.042

    Article  PubMed  Google Scholar 

  38. Dinnewitzer AJ, Wexner SD, Baig MK et al (2006) Timing of restorative proctectomy following subtotal colectomy in patients with inflammatory bowel disease. Colorectal Dis 8(4):278–282. https://doi.org/10.1111/j.1463-1318.2005.00933.x

    Article  CAS  PubMed  Google Scholar 

  39. Nickerson TP, Merchea A (2016) Perioperative considerations in Crohn disease and ulcerative colitis. Clin Colon Rectal Surg 29(2):80–84. https://doi.org/10.1055/s-0036-1580633

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Beaumont Hospital, Dublin 9, Ireland

    Lucy Burns

  2. Department of Surgery, St James’ Hospital, Dublin 8, Ireland

    Michael E. Kelly

  3. Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland

    Maria Whelan, James O’Riordan, Paul Neary & Dara O. Kavanagh

Authors
  1. Lucy Burns
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael E. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Whelan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James O’Riordan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul Neary
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dara O. Kavanagh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucy Burns.

Ethics declarations

Ethics

This was a retrospective study, to audit patient outcomes in our institution. It was registered as an audit in the institution, and ethical approval was not sought.

Conflict of interest

The authors declare no competing interests.

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

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burns, L., Kelly, M.E., Whelan, M. et al. A contemporary series of surgical outcomes following subtotal colectomy and/or completion proctectomy for management of inflammatory bowel disease. Ir J Med Sci 191, 2705–2710 (2022). https://doi.org/10.1007/s11845-021-02907-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-021-02907-6

Keywords

Search

Navigation