Laparoscopic Total Colectomy for Patients With Severe Ulcerative Colitis. Can We Improve the Results?

Alejandro G Canelas, MD, Maximiliano E Bun, MD, Esteban Grzona, MD, Mariano Laporte, MD, Federico Carballo, MD, Nicolás A Rotholtz, MD. Hospital Alemán, Buenos Aires, Argentina


The surgical treatment of patients with ulcerative colitis (UC) is total proctocolectomy with ileal pouch-anal anastomosis. This surgery can be performed by laparoscopy with excellent results. It is not clear which is the impact of this approach in the management of patients with severe colitis who require emergency surgery. There is scarce data showing that laparoscopic approach has lower morbidity and hospital stay compared with the conventional approach, but has longer surgical time and morbidity during the learning curve. The aim of this study is to assess if the acquisition of experience by the surgical team can improve the outcomes of laparoscopic total colectomy in severe ulcerative colitis.

A retrospective study was performed using a prospective collected database. All patients with severe ulcerative colitis who underwent urgent laparoscopic total colectomy between August 2003 and July 2011 were included. The severity of the colitis was graded by clinical evaluation, using the Truelove and Witts Ulcerative index, and colonoscopy. The series was divided into two groups: the first 20 surgeries (G1); and the last 15 surgeries (G2). Perioperative outcomes of the two groups were compared by univariate analysis.

There were no differences in the demographic data between the two groups.
G2 had shorter surgical time (G1: 199 +/- 39 vs. G2: 170 +/- 29 minutes; p < 0.05). There were no differences in the rate of intraoperative complications and in the conversion rate, but the only patient who was converted to laparotomy belonged to G1.
There were no differences in the postoperative complication rate, return to bowel function, postoperative length of stay and in the time to complete proctectomy with ileo-anal pouch.

The acquisition of experience by the surgical team in laparoscopic total colectomy for patients with severe UC decreases the surgical time and shows a tendency to decrease the conversion rate.

Session Number: Poster – Poster Presentations
Program Number: P085
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