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Journal of Gastrointestinal Surgery

Erschienen in:

01.04.2009 | original article

Colectomy in Patients with Acute Colitis: A Systematic Review

verfasst von: P. H. E. Teeuwen, M. W. J. Stommel, A. J. A. Bremers, G. J. van der Wilt, D. J. de Jong, R. P. Bleichrodt

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 4/2009

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Abstract

Background

For patients with acute colitis, the decision when and how to operate is difficult in most cases. It was the aim of this systematic review to analyze early mortality and morbidity of colectomy for severe acute colitis in order to identify opportunities to improve perioperative treatment and outcome.

Methods

A systematic review of the available literature in the Medline and PubMed databases from 1975 to 2007 was performed. All articles were assessed methodologically; the articles of poor methodological quality were excluded. Articles on laparoscopic colectomy for acute colitis were analyzed separately.

Results

In total, 29 studies met the criteria for the systematic review, describing a total of 2,714 patients, 1,257 of whom were operated on in an acute setting, i.e., urgent or emergency colectomy. Reported in-hospital mortality was 8.0%; the 30-day mortality was 5.2%. Morbidity was 50.8%. The majority of complications were of infectious and thromboembolic nature. Over the last three decades, there was a shift in indications from toxic megacolon, from 71.1% in 1975–1984 to 21.6% in 1995–2005, to severe acute colitis not responding to conservative treatment, from 16.5% in 1975–1984 to 58.1% in 1995–2007. Mortality decreased from 10.0% to 1.8%. Morbidity remained high, exceeding 40% in the last decade. Mortality after laparoscopic surgery was 0.6%. Complication rate varies from 16–37%.

Conclusion

Colectomy for acute colitis is complicated by considerable morbidity. The incidence of adverse outcome has substantially decreased over the last three decades, but further improvements are still required. The retrospective nature of the included studies allows for a considerable degree of selection bias that limits robust and clinically sound conclusions about both conventional and laparoscopic surgery.

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Titel: Colectomy in Patients with Acute Colitis: A Systematic Review
verfasst von: P. H. E. Teeuwen
M. W. J. Stommel
A. J. A. Bremers
G. J. van der Wilt
D. J. de Jong
R. P. Bleichrodt
Publikationsdatum: 01.04.2009
Verlag: Springer-Verlag
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 4/2009
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0792-4

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Colectomy in Patients with Acute Colitis: A Systematic Review