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* = Presenting author

P569 Systemic and peritoneal inflammatory response after laparoscopic vs open emergency colectomy for acute severe ulcerative colitis

T. Yamamoto*, T. Shimoyama, K. Matsumoto

Yokkaichi Hazu Medical Centre, Inflammatory Bowel Disease Centre, Yokkaichi, Japan

Background

In comparisons of laparoscopic and open surgery, significantly better protection of the systemic immune system was shown with laparoscopic cholecystectomy and Nissen fundoplication than with the conventional approach. These findings have not been investigated in patients with acute severe ulcerative colitis (UC) who require emergency colectomy. This study was to evaluate differences in both the systemic and peritoneal immune response after laparoscopic and open emergency colectomy in patients with acute severe UC.

Methods

Thirty patients underwent hand-assisted laparoscopic colectomy and 30 patients open colectomy. All patients underwent total colectomy with closure of the rectal stump and construction of an end-ileostomy. Interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α in plasma and peritoneal fluid from a drainage tube were measured on postoperative days 0, 1, 3 and 7. Leukocyte and platelet counts, and C-reactive protein (CRP) levels were also measured perioperatively. Further, incidence of septic complications such as leak, fistula, intra-abdominal abscess or wound infection was investigated.

Results

Between the two groups, patients were matched with respect to age, sex, UC duration, severity, extent, and medications at surgery. Septic complications occurred in 3 patients in each group. IL-1β, IL-6 and TNF-α levels in plasma and peritoneal fluid were not significantly different between the two groups during the entire study period. Similarly, leukocyte and platelet counts, and CRP levels were not significantly different between the two groups during the study period.

Conclusion

Based on the assays of IL-1β, IL-6 and TNF-α levels in the plasma and the peritoneal fluid, this study did not show any significant differences in the systemic and peritoneal immune response after laparoscopic vs open emergency colectomy in patients with acute severe UC. Likewise, surgical approaches did not affect the incidence of septic complications. This study shows that laparoscopic approach can be safely performed for patients with acute severe UC who required emergency colectomy.