Emergency Laparoscopic Approach in Patients with Ulcerative Colitis

Alejandro Canelas, MD, Esteban Grzona, MD, Mariano Laporte, MD, Maximiliano Bun, MD, Nicolás Rotholtz, MD. Colorectal Surgery Section. Hospital Alemán. Buenos Aires – Argentina.

INTRODUCTION: The surgical treatment of choice in patients with ulcerative colitis (UC) is the restorative proctocolectomy with ileo-anal J pouch. This surgery is performed laparoscopically with excellent results. In patients with severe disease or deteriorate clinical conditions, surgery should be done in 3 steps, performing primarily a subtotal colectomy. In these circumstances the laparoscopic approach is debatable. The aim of this paper is to evaluate the feasibility and results of laparoscopic subtotal colectomy in patients with severe UC or poor clinical condition.

METHODS AND PROCEDURES: A retrospective analyses from a prospective database was made from all patients who underwent laparoscopic subtotal colectomy for severe UC or poor clinical condition between August 2003 to July 2010. To categorize the disease activity the Truelove and Witts index as well as endoscopic findings were used.

RESULTS: In the study period 58 patients were operated for UC. Thirty two (55%) of those required 3 steps: 24 (75%) for severe refractory acute disease (receiving steroids at doses higher than 30 mg of prednisone daily or equivalent) and 8 (25%) for poor clinical condition (albumin levels lower than 3 g/dl). 19 (59%) were male. The average age was 32 ± 14 (18-68) years. The values of the preoperative variables were: body mass index 21 ± 4 (12-29) kg/m², serum albumin 3.1 ± 0.6 (1.9-4.6) gs/dL, Hb 10.6 ± 1.8 (8.1-14.5) gs / dl. The operative time was 188 ± 38 (130-300) minutes. One patient (3%) required conversion due to a megacolon. The average hospital stay was 4.5 ± 2.3 (3-12) days. The postoperative complication rate was 43.7%. There was no mortality in the series. The average time to perform the proctectomy with ileo-anal J pouch was 87 ± 59 (38-385) days. In 88% of cases the second step could be completed laparoscopically.

CONCLUSION: The laparoscopic approach in patients with severe UC or poor clinical condition is feasible and safe.