Marie Monsinjon1, Diane Mege1, Léon Maggiori1, Xavier Treton2, Yoram Bouhnik2, Yves Panis3,4. 1. Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France. 2. Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France. 3. Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France. yves.panis@aphp.fr. 4. Service de Chirurgie Colorectale, Pôle des Maladies de L'Appareil Digestif (PMAD), Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France. yves.panis@aphp.fr.
Abstract
PURPOSE: The aim of medical treatment of severe acute colitis (SAC) complicating inflammatory bowel disease (IBD) is to avoid surgery, but in 20 to 50% of the cases, colectomy remains necessary. This study aimed to determine the impact of the different lines of medical therapy (i.e., steroids, anti-TNF, or ciclosporin) on postoperative course after laparoscopic subtotal colectomy for SAC complicating IBD. METHODS: All the patients who underwent laparoscopic subtotal colectomy for SAC were included and divided into two groups: those who presented with postoperative morbidity (group A) and those with an uneventful postoperative course (group B). Preoperative physical, endoscopic and radiological data, and medical treatments were compared between groups. RESULTS: From 2006 to 2015, 65 consecutive patients (32 males, median age = 35 [17-87] years) operated for SAC were included. Postoperative morbidity occurred in 19 patients (29%, group A) and was mainly represented by surgical morbidity (n = 15), including ileus (n = 9), stoma-related complications (n = 5), and intra-abdominal abscess (n = 4). Lichtiger score, endoscopic and radiological evaluations were similar between groups. Patients with morbidity had more frequently presented two previous episodes of SAC (26%) than those without (7%, p = 0.04). Duration of anti-TNF treatment was more frequently longer than 2 months in group A (67%) than that in group B (14%, p = 0.04). No significant differences between groups were noted regarding other preoperative medical treatments and number of lines therapy. CONCLUSION: This study suggests that postoperative course after laparoscopic subtotal colectomy for SAC is affected by prolonged preoperative anti-TNF therapy, and in the case of recurrent SAC.
PURPOSE: The aim of medical treatment of severe acute colitis (SAC) complicating inflammatory bowel disease (IBD) is to avoid surgery, but in 20 to 50% of the cases, colectomy remains necessary. This study aimed to determine the impact of the different lines of medical therapy (i.e., steroids, anti-TNF, or ciclosporin) on postoperative course after laparoscopic subtotal colectomy for SAC complicating IBD. METHODS: All the patients who underwent laparoscopic subtotal colectomy for SAC were included and divided into two groups: those who presented with postoperative morbidity (group A) and those with an uneventful postoperative course (group B). Preoperative physical, endoscopic and radiological data, and medical treatments were compared between groups. RESULTS: From 2006 to 2015, 65 consecutive patients (32 males, median age = 35 [17-87] years) operated for SAC were included. Postoperative morbidity occurred in 19 patients (29%, group A) and was mainly represented by surgical morbidity (n = 15), including ileus (n = 9), stoma-related complications (n = 5), and intra-abdominal abscess (n = 4). Lichtiger score, endoscopic and radiological evaluations were similar between groups. Patients with morbidity had more frequently presented two previous episodes of SAC (26%) than those without (7%, p = 0.04). Duration of anti-TNF treatment was more frequently longer than 2 months in group A (67%) than that in group B (14%, p = 0.04). No significant differences between groups were noted regarding other preoperative medical treatments and number of lines therapy. CONCLUSION: This study suggests that postoperative course after laparoscopic subtotal colectomy for SAC is affected by prolonged preoperative anti-TNF therapy, and in the case of recurrent SAC.
Entities:
Keywords:
Biological therapy; Inflammatory bowel disease; Medical treatment; Severe acute colitis; Subtotal colectomy
Authors: Lotte C Dinesen; Alissa J Walsh; Marijana Nedeljkovic Protic; Graham Heap; Fraser Cummings; Bryan F Warren; Bruce George; Neil J M Mortensen; Simon P L Travis Journal: J Crohns Colitis Date: 2010-02-19 Impact factor: 9.071
Authors: Jean Frédéric Colombel; Edward V Loftus; William J Tremaine; John H Pemberton; Bruce G Wolff; Tonia Young-Fadok; William S Harmsen; Cathy D Schleck; William J Sandborn Journal: Am J Gastroenterol Date: 2004-05 Impact factor: 10.864
Authors: M Ferrante; A D'Hoore; S Vermeire; S Declerck; M Noman; G Van Assche; I Hoffman; P Rutgeerts; F Penninckx Journal: Inflamm Bowel Dis Date: 2009-07 Impact factor: 5.325