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17.09.2017 | Short Communication | Ausgabe 1/2018

International Journal of Colorectal Disease 1/2018

Early colectomy in steroid-refractory acute severe ulcerative colitis improves operative outcome

Zeitschrift:
International Journal of Colorectal Disease > Ausgabe 1/2018
Autoren:
Sujeet Kumar Saha, Rajesh Panwar, Ameet Kumar, Sujoy Pal, Vineet Ahuja, Nihar Ranjan Dash, Govind Makharia, Peush Sahni
Wichtige Hinweise
Sujeet Kumar Saha and Rajesh Panwar contributed equally to this work.
Part of this study was presented at the 38th National Congress of Association of Colon and Rectal Surgeons of India (ACRSICON 2015) held at New Delhi from 17 to 20 September 2015 and received the Best Oral Paper award.

Abstract

Purpose

Up to a third of patients with acute severe ulcerative colitis (ASUC) fail to respond to intensive steroid therapy and eventually require a salvage colectomy. We have previously reported that the mortality of emergency colectomy can be decreased by offering it within the first week of intensive medical therapy. We implemented this policy and report the results of our experience.

Methods

The clinical records of all patients with ASUC who underwent emergency colectomy after failure of medical therapy between January 2005 and July 2015 were extracted from a prospectively maintained database. The data were analysed with regard to duration of intensive medical therapy, timing of surgery, in-hospital mortality and post-operative complications.

Results

Eighty-eight patients underwent emergency surgery for ASUC after failed medical therapy. Of these, 75 (85.2%) were operated within 7 days of initiation of intensive medical therapy [n = 51 (58%) were operated < 5 days]. One patient who was operated on day 8 following steroid therapy died postoperatively. The current post-operative mortality of 1.1% (1/88) was significantly lower than the mortality noted in the previously recorded retrospective case series [8/51 (15.6%); p = 0.001]. In addition, the incidence of overall (9/13 vs. 23/75; p = 0.012) and clinically significant (12/75 vs. 6/13; p = 0.022) complications was significantly higher in patients operated after 7 days as compared to those operated within 7 days.

Conclusion

The policy of early colectomy, within 7 days, in patients with ASUC who fail to respond to intensive steroid-based therapy improves perioperative outcomes with significantly low in-hospital mortality and morbidity.

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