P563 Subtotal colectomy for ulcerative colitis: distinct short-term and long-term advantages of the laparoscopic approach
N. Buchs*1, A. Bloemendaal2, C. Wood2, N. Mortensen3, R. Guy3, B. George3
1Oxford University Hospitals, Department of Colorectal Surgery, Oxford, United Kingdom, 2OUH, Oxford, United Kingdom, 3Oxford University Hospitals, Oxford, United Kingdom
Subtotal colectomy (STC) is a well-established treatment for complicated and refractory ulcerative colitis (UC). Laparoscopic approaches offer potentially improved outcomes. The aim of this study is to report our experience with STC for UC in a tertiary centre.
All patients undergoing STC for UC between January 2007 and May 2015 were retrospectively analysed from a prospectively managed database. Patients with Crohn’s disease, indeterminate colitis, or undergoing 1-stage procedures were excluded. Demographics, perioperative outcomes, and second-stage procedures were analysed.
During the study period, 151 STC were performed for UC (100 emergent [66.2%] and 51 elective [33.8%]). Refractory and severe colitis were the most common indications (61.6%). Overall, 117 laparoscopic (77.5%) and 34 open STC were performed, with a conversion rate of 14.5%. Mortality and morbidity rates were 0.7% and 38.4%, respectively. Reoperation rate for all patients was 12.6%. The mean hospital stay was 12 days (range: 3–67). Whilst operative time was shorter for open STC (minus 75 minutes; p = 0.001), there were fewer complications (31.6% vs 61.9%; p = 0.002) and a shorter hospital stay (minus 6.9 days; p = 0.0002) following laparoscopic STC. To date, two-thirds of patients have undergone a second-stage procedure (ileoanal pouch or completion proctectomy only). Patients undergoing open STC were less likely to undergo a restorative second-stage procedure (pouch) than those having laparoscopic STC (32.4% vs 16.2%; p = 0.05).
Laparoscopic STC for UC is feasible and safe, even in the emergency situation. A laparoscopic approach offers advantages in terms of lower morbidity, reduced length of stay, and a greater likelihood of future ileal pouch surgery.