Restorative proctocolectomy in elective and emergency cases of ulcerative colitis.
A consecutive series of restorative proctocolectomy for ulcerative colitis was reviewed to determine whether an emergency restorative proctocolectomy procedure leads to a higher morbidity, more especially anastomotic leakage. Severity of illness and nature of surgery were divided in two categories: (1) no acute disease and elective surgery (18 patients), (2) acute disease requiring emergency surgery either immediately or within one week of admission (12 patients). Morbidity after elective surgery was 27% and after emergency surgery 66% (P < 0.06). Pouch-anal leakage occurred in 11% and 41% respectively (P = 0.08). Five risk factors significantly influenced the leak rate including preoperative white blood cell count > 10,000/microliter (P < 0.02), urgent nature of surgery (P < 0.02), the combination of leucocytosis and urgent nature of surgery (P = 0.02), the combination of leucocytosis and preoperative corticosteroid dose equivalent to > or = 200 mg hydrocortisone/24 h (P = 0.006), postoperative pelvic haematoma (P < 0.05). In conclusion, restorative proctocolectomy is contraindicated in emergency circumstances, especially in patients with signs of sepsis on a high corticosteroid dose. To reduce operative risk and number of procedures required, patients with relapsing ulcerative colitis should be referred for restorative proctocolectomy while being in remission.
Heyvaert
G
G
Department of Abdominal Surgery, University Clinic Gasthuisberg, Catholic University of Leuven, Belgium.
Penninckx
F
F
Filez
L
L
Aerts
R
R
Kerremans
R
R
Rutgeerts
P
P
D000328:Adult; D015984:Causality; D003093:Colitis, Ulcerative / Q000453:epidemiology / Q000601:surgery*; D000075202:Contraindications; D004630:Emergencies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology*; D016737:Proctocolectomy, Restorative; D012307:Risk Factors
D006854:Hydrocortisone