Minimally invasive subtotal colectomy and ileal pouch-anal anastomosis for fulminant ulcerative colitis: a reasonable approach?

Abstract

PURPOSE:

This study was designed to evaluate the safety, feasibility, and short-term outcomes of three-stage minimally invasive surgery for fulminant ulcerative colitis.

METHODS:

Using a prospective database, we identified all patients with ulcerative colitis who underwent minimally invasive surgery for both subtotal colectomy and subsequent ileal pouch-anal anastomosis at our institution from 2000 to 2007. Demographics and short-term outcomes were retrospectively evaluated.

RESULTS:

During seven years, 50 patients underwent minimally invasive subtotal colectomy for fulminant ulcerative colitis; 50 percent were male, with a median age of 34 years. All patients had refractory colitis: 96 percent were taking steroids, 76 percent were recently hospitalized, 59 percent had >/=5 kg weight loss, 57 percent had anemia that required transfusions, 30 percent were on biologic-based therapy, and 96 percent had >/=1 severe Truelove & Witts' criteria. Of these 50 procedures, 72 percent were performed by using laparoscopic-assisted and 28 percent with hand-assisted techniques. The conversion rate was 6 percent. Subsequently, minimally invasive completion proctectomy with ileal pouch-anal anastomosis was performed in 42 patients with a 2.3 percent conversion rate. Median length of stay after each procedure was four days. There was one anastomotic leak and no mortality.

CONCLUSIONS:

A staged, minimally invasive approach for patients with fulminant ulcerative colitis is technically feasible, safe, and reasonable operative strategy, which yields short postoperative length of stay.

• Authors: Stefan D Holubar, David W Larson, Eric J Dozois, Jirawat Pattana-Arun, John H Pemberton, Robert R Cima
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 52 Issue 2 Pg. 187-92 (Feb 2009) ISSN: 1530-0358 [Electronic] United States
• PMID: 19279410 (Publication Type: Journal Article)

Topics

• Adult
• Colectomy
• Colitis, Ulcerative (surgery)
• Colonic Pouches
• Female
• Humans
• Male
• Minimally Invasive Surgical Procedures
• Postoperative Complications
• Proctocolectomy, Restorative