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P180. Laparoscopic emergency colectomy for ulcerative colitis is associated with fewer adhesions compared to open emergency colectomy

S.A.L. Bartels, M.S. Vlug, D. Henneman, P.J. Tanis, W.A. Bemelman

Academic Medical Centre, Amsterdam, The Netherlands

Aim: The aim of this study was to determine whether the need for adhesiolysis during completion proctectomy (CP) with ileo pouch anal anastomosis (IPAA) is influenced by the surgical approach of the initial emergency colectomy for ulcerative colitis and the hospital setting.

Materials and Methods: One hundred consecutive patients who underwent CP with IPAA in our center between January 1999 and April 2010 were included. Emergency colectomy was performed laparoscopically in 30 out of 52 patients at the Academic Medical Center, Amsterdam and in 6 out of 48 patients at referring hospitals. Case files of these patients were retrospectively reviewed.

Results: Significantly more adhesiolysis was performed after open compared to laparoscopic colectomy (75% vs. 19%, P < 0.001). In univariate analysis, emergency colectomy at a referring hospital was also predictive for adhesiolysis (70% vs. 40%, P = 0.003), but ‘approach of the initial colectomy’ was the only independent predictive factor for the need for adhesiolysis (P < 0.001) in a multivariable logistic regression analysis. Interval to CP was longer after open colectomy and after colectomy performed at a referring hospital. Significantly more incisional hernia corrections during CP were performed after open emergency colectomy (14% vs. 0%, P = 0.024). Operating time, overall morbidity and post operative hospital stay of CP were not related to surgical approach or hospital setting of the emergency colectomy.

Conclusion: Laparoscopic as opposed to open emergency colectomy is associated with less need for adhesiolysis, less incisional hernias and shorter interval to completion proctectomy.