Matthew Skancke, Dr, Khashayar Vaziri, Dr, Richard Amdur, Bindu Umapathi, Dr, Vincent Obias. George Washington University
Background: The adoption of the laparoscopic approach to complex abdominal surgery has grown, and minimally invasive treatment for ulcerative colitis (UC) has gained popularity. We evaluated the outcomes of emergent laparoscopic and open total abdominal colectomy (TAC) of UC.
Methods: The 2012-2015 ACS-NSQIP and targeted colectomy databases were queried for patients undergoing TAC emergently for UC. Patients admitted to the hospital for more than 20 days prior to surgery and those in septic shock were excluded. Statistical analysis incorporated t-test and binomial logistic regression with p<0.05 holding significance. The primary outcome of interest was morbidity and mortality within 30 days following surgery.
Results: This search identified 209 patients undergoing open (163) and laparoscopic (47) TAC emergently for UC. Patients undergoing open TAC were older (p=0.003), had more comorbidities and were more inflammatory (SIRS or Sepsis 63% vs. 36%, p=0.001). Laparoscopic operative times were also longer than laparotomy (219 vs. 152 min, p<0.001) and had a 13% conversion rate. Within the 30 days postoperative period, patients who underwent laparotomy had a higher morbidity (69% vs. 42%, p=0.001), higher mortality (13% vs. 2%, p=0.034) and a longer postoperative length of stay (14.5 days vs. 10.4 days, p= 0.037) compared to laparoscopic total abdominal colectomy. After controlling for the differences in cohorts, regression analysis indicated that a laparoscopic approach had a protective effect on postoperative morbidity (OR 0.439, CI 0.206 to 0.933, p=0.032) but no significant effect on mortality (p=0.296).
Conclusion: Emergent laparoscopic TAC for UC reduces composite morbidity without effecting mortality when compared to open TAC. Laparoscopic TAC should be considered for emergent UC patients who are not in septic shock.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88431
Program Number: P267
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster