Sujeet Kumar Saha1, Rajesh Panwar1, Ameet Kumar1, Sujoy Pal2, Vineet Ahuja3, Nihar Ranjan Dash1, Govind Makharia3, Peush Sahni1. 1. Department of Gastrointestinal Surgery & Liver Transplantation, All India Institute of Medical Sciences, Room 1005, 1st floor Academic Block, New Delhi, 110029, India. 2. Department of Gastrointestinal Surgery & Liver Transplantation, All India Institute of Medical Sciences, Room 1005, 1st floor Academic Block, New Delhi, 110029, India. sujoypal@hotmail.com. 3. Department of Gastroenterology & Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
Abstract
PURPOSE: Up to a third of patients with acute severe ulcerative colitis (ASUC) fail to respond to intensive steroid therapy and eventually require a salvage colectomy. We have previously reported that the mortality of emergency colectomy can be decreased by offering it within the first week of intensive medical therapy. We implemented this policy and report the results of our experience. METHODS: The clinical records of all patients with ASUC who underwent emergency colectomy after failure of medical therapy between January 2005 and July 2015 were extracted from a prospectively maintained database. The data were analysed with regard to duration of intensive medical therapy, timing of surgery, in-hospital mortality and post-operative complications. RESULTS: Eighty-eight patients underwent emergency surgery for ASUC after failed medical therapy. Of these, 75 (85.2%) were operated within 7 days of initiation of intensive medical therapy [n = 51 (58%) were operated < 5 days]. One patient who was operated on day 8 following steroid therapy died postoperatively. The current post-operative mortality of 1.1% (1/88) was significantly lower than the mortality noted in the previously recorded retrospective case series [8/51 (15.6%); p = 0.001]. In addition, the incidence of overall (9/13 vs. 23/75; p = 0.012) and clinically significant (12/75 vs. 6/13; p = 0.022) complications was significantly higher in patients operated after 7 days as compared to those operated within 7 days. CONCLUSION: The policy of early colectomy, within 7 days, in patients with ASUC who fail to respond to intensive steroid-based therapy improves perioperative outcomes with significantly low in-hospital mortality and morbidity.
PURPOSE: Up to a third of patients with acute severe ulcerative colitis (ASUC) fail to respond to intensive steroid therapy and eventually require a salvage colectomy. We have previously reported that the mortality of emergency colectomy can be decreased by offering it within the first week of intensive medical therapy. We implemented this policy and report the results of our experience. METHODS: The clinical records of all patients with ASUC who underwent emergency colectomy after failure of medical therapy between January 2005 and July 2015 were extracted from a prospectively maintained database. The data were analysed with regard to duration of intensive medical therapy, timing of surgery, in-hospital mortality and post-operative complications. RESULTS: Eighty-eight patients underwent emergency surgery for ASUC after failed medical therapy. Of these, 75 (85.2%) were operated within 7 days of initiation of intensive medical therapy [n = 51 (58%) were operated < 5 days]. One patient who was operated on day 8 following steroid therapy died postoperatively. The current post-operative mortality of 1.1% (1/88) was significantly lower than the mortality noted in the previously recorded retrospective case series [8/51 (15.6%); p = 0.001]. In addition, the incidence of overall (9/13 vs. 23/75; p = 0.012) and clinically significant (12/75 vs. 6/13; p = 0.022) complications was significantly higher in patients operated after 7 days as compared to those operated within 7 days. CONCLUSION: The policy of early colectomy, within 7 days, in patients with ASUC who fail to respond to intensive steroid-based therapy improves perioperative outcomes with significantly low in-hospital mortality and morbidity.
Entities:
Keywords:
Acute severe ulcerative colitis; Colectomy; Emergency
Authors: Gilaad G Kaplan; Ellen P McCarthy; John Z Ayanian; Joshua Korzenik; Richard Hodin; Bruce E Sands Journal: Gastroenterology Date: 2008-01-10 Impact factor: 22.682
Authors: Shanika de Silva; Christopher Ma; Marie-Claude Proulx; Marcelo Crespin; Belle S Kaplan; James Hubbard; Martin Prusinkiewicz; Andrew Fong; Remo Panaccione; Subrata Ghosh; Paul L Beck; Anthony Maclean; Donald Buie; Gilaad G Kaplan Journal: Clin Gastroenterol Hepatol Date: 2011-07-30 Impact factor: 11.382
Authors: Fabrizio Michelassi; John Lee; Michele Rubin; Alessandro Fichera; Kristen Kasza; Theodore Karrison; Roger D Hurst Journal: Ann Surg Date: 2003-09 Impact factor: 12.969
Authors: Olga A Lavryk; Luca Stocchi; Tracy L Hull; Jeremy M Lipman; Sherief Shawki; Stefan D Holubar; Conor P Delaney; Scott R Steele Journal: Int J Colorectal Dis Date: 2019-11-23 Impact factor: 2.571
Authors: Ira L Leeds; Margaret H Sundel; Alodia Gabre-Kidan; Bashar Safar; Brindusa Truta; Jonathan E Efron; Sandy H Fang Journal: Dis Colon Rectum Date: 2019-05 Impact factor: 4.585
Authors: Ira L Leeds; Christian Jones; Sandra R DiBrito; Joseph V Sakran; Elliott R Haut; Alistair J Kent Journal: Surg Endosc Date: 2019-11-18 Impact factor: 4.584