P285. Complications associated with colectomy in patients with ulcerative colitis
P. Leonard1, M. Yang2, J. Chao2, P. Mulani2
1Thomas Jefferson Medical College, Philadelphia, United States; 2Abbott Laboratories, Illinois, United States
Background: In ulcerative colitis (UC), surgery is often recommended for patients who are not responding to conventional medical therapy [1]. We estimated the prevalence of complications of colectomy in patients with UC, using meta-analysis of published studies.
Methods: A systematic literature search in PubMed (through August 2011) was conducted for “ulcerative colitis” and the following: ileum, ileal, pouch-anal anastomosis, and complications. Studies with primary data collected from reports of complication rates associated with colectomy were analysed. For complications with the highest prevalence, pooled averages across studies were estimated. The heterogeneity among studies was examined using the Cochran's Q‑test to decide which model should be used (DerSimonian and Laird random-effects model with random effects applied on the logit scale if heterogeneity existed or fixed-effects model if no heterogeneity).
Results: Pouchitis, chronic pouchitis, small bowel obstruction, small bowel obstruction requiring reoperation, and infertility in patients undergoing colectomy were analysed using meta-analysis; the random-effects model was used for all estimates due to heterogeneity among studies. From 16 studies, the estimated prevalence of nonchronic pouchitis (≤3 episodes per year) was 28.4% (95% CI: 21.7–36.2%) (table). From 7 studies, the estimated prevalence of chronic pouchitis (≥4 episodes per year) was 10.9% (95% CI: 6.6–17.4%). From 2 studies that included infertility data, the prevalence of infertility after surgery was about 6 times the presurgery rate. From 15 studies, the estimated prevalence of small bowel obstruction was 17.8% (95% CI: 13.5–23.2%). From 7 studies, the estimated prevalence of small bowel obstruction requiring reoperation was 24.5% (95% CI: 14.9–37.5%).
| Complication | Rate (%) | 95% CI |
|---|---|---|
| Nonchronic pouchitisa,b | 28.4 | 21.7–36.2 |
| Chronic pouchitisb,c | 10.9 | 6.6–17.4 |
| Small bowel obstructionb | 17.8 | 13.5–23.2 |
| Requiring reoperation | 24.5 | 14.9–37.5 |
| Infertilityb | ||
| Before colectomy | 7.8 | 2.5–22.0 |
| After colectomy | 47.9 | 41.0–54.8 |
Conclusions: Patients with moderate to severe UC experienced substantial complications associated with colectomy. This suggested that alternative therapies might need to be considered before undergoing surgical intervention if conventional medical therapies failed [1].
1. Kornbluth A, et al. (2010), Am J Gastroenterol, 501–23.