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Emergency colectomy for acute severe ulcerative colitis: a nationwide survey on technical strategies of the Italian society of colorectal surgery (SICCR)

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Abstract

Emergency subtotal colectomy is the standard treatment for acute severe ulcerative colitis (ASUC) unresponsive to medical treatment. No guidelines are available about surgical technique. The aim of the current survey was to identify the attitudes of Inflammatory Bowel Disease (IBD) surgeons concerning colectomy in patients with ASUC by means of a nationwide survey, with specific focus on intraoperative technical details. A survey was developed with focus on number of procedures performed, approach to vascular ligation, technique of bowel dissection, treatment of the omentum and of the rectal stump. Twenty Centres completed the survey. Seventy percent of responders started the colectomy laparoscopically. No significant differences were observed about vessels and mesocolic dissection as well as on the choice of the starting colon side and management of the omentum. Ileocolic vessels were ligated distally by 70% and at the origin by 30% and those who transect mesenteric vessels distally are significatively more likely to perform the dissection from lateral to medial and to cut the middle colic vessels distally and 100% of the ones linking left vessels at mesenteric axis transect middle colic vessels at the origin. No differences were observed in the treatment of rectal stump; however, all surgeons who performed a transrectal drainage (45%) left the rectal stump intraperitoneal (p < 0.05). No consensus exists about the technique of dissection, vascular ligation, treatment of the omentum and management of rectal stump. Further studies are needed to evaluate the impact of the different surgical techniques on patients’ outcomes.

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Acknowledgements

The authors acknowledge the Italian Group for the study of Inflammatory Bowel Disease (IG-IBD) and the Società Italiana di Chirurgia Colorettale (Italian Society of Colorectal Surgery, SICCR) for the contribution in the dissemination of the survey.

Funding

No specific funding was received for the present study.

Author information

Authors and Affiliations

  1. Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy

    Michela Mineccia, Serena Perotti & Alessandro Ferrero

  2. Department of Advanced Medical and Surgical Science, “Università Degli Studi Della Campania Luigi Vanvitelli”, Naples, Italy

    Gianluca Pellino

  3. Colorectal Surgery, Vall d’hebron University Hospital, Barcellona, Spain

    Gianluca Pellino

  4. Division of Surgery, ASST Rhodense, Rho Memorial Hospital, 20017, Milan, Italy

    Gianluca Matteo Sampietro

  5. Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

    Valerio Celentano

  6. Department of Surgery and Cancer, Imperial College London, London, UK

    Valerio Celentano

  7. Department of Gastroenterologia, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy

    Rodolfo Rocca & Marco Daperno

Authors
  1. Michela Mineccia
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  2. Serena Perotti
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  3. Gianluca Pellino
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  4. Gianluca Matteo Sampietro
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  5. Valerio Celentano
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  6. Rodolfo Rocca
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  7. Marco Daperno
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  8. Alessandro Ferrero
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MM, SP, and GP. The first draft of the manuscript was written by MM with VC and GMS. RR, MD, and AF reviewed the manuscript and contributed to the final version, which was approved by all authors.

Corresponding author

Correspondence to Michela Mineccia.

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The authors declare to not have any financial interest directly related to the work and to not have any conflict of interest.

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All procedures in our paper were in accordance with the ethical standards of the institutional as well as national research committee and with the 1964 Helsinki Declaration and its later amendments.

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This articles does not contain any studies with human participants or animal performed by any of the authors.

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Mineccia, M., Perotti, S., Pellino, G. et al. Emergency colectomy for acute severe ulcerative colitis: a nationwide survey on technical strategies of the Italian society of colorectal surgery (SICCR). Updates Surg 74, 1563–1569 (2022). https://doi.org/10.1007/s13304-022-01339-w

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