Laparoscopic Subtotal Colectomy for Medically Refractory Ulcerative Colitis: The Time Has Come

Introduction:
We hypothesized that laparoscopic subtotal colectomy (STC) is a safe alternative in patients with medically refractory ulcerative colitis (UC).
Methods:
This is a retrospective study of 85 medically refractory UC patients undergoing STC with end ileostomy since 2002. Patients with toxic megacolon were excluded. Results are presented as mean with confidence interval and compared using unpaired t-test with two-tail distribution.
Results:
85 patients underwent STC, 56 open (OC) and 29 laparoscopic (LC). Patients were equally matched for gender, ASA score and comorbidity. Age was significantly different between the two groups, LC younger than OC (33.9±4.96 vs. 41.4±5.3 respectively, p 0.05) All patients were on steroids preoperatively. No mortalities occurred in either group. Major morbidity was defined as a life-threatening complication, readmission or re-operation within 30 days and was equivalent in both groups (OC 19% vs. LC 17%, p 0.78). Significant postoperative complications included 7 wound infections with 5 wound dehiscence in OC (OC 21.4% vs. LC 0%, p 0.003). Postoperative ileus (POI) was higher in LC, but not statistically significant (OC 10.1% vs. LC 17%, p 0.43).
For patients without major complications, length of hospital stay (4.53±0.74 vs. 6±1.32 days, p 0.0006) and intraoperative blood loss (EBL) (98.45±32.91 vs. 169.23±29.82 mL, p 0.01) were significantly decreased in LC. Intraoperative time was longer in LC (215.65±29.06 vs. 171.08±18.98 minutes, p 0.014). For both OC and LC, postoperative complication rate correlated with intraoperative EBL. Time to reversal and percentage of patients reversed were similar in both groups.
Conclusion:
Serious morbidity was equivalent in both groups. Intraoperative EBL predicts the probability of postoperative complication. Laparoscopy, although associated with a slightly higher rate of POI, confers the benefits of improved cosmesis, negligible wound complications, shorter hospital stay and reduced intraoperative blood loss. We conclude that laparoscopy is a feasible and safe alternative to open surgery in this patient population.

Session: Podium Presentation

Program Number: S002