title: Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come.
abstract: OBJECTIVE
  To evaluate laparoscopic versus open subtotal colectomy (STC) in patients with ulcerative colitis (UC) requiring urgent or emergent operative intervention.
  
  
  METHODS
  A retrospective review was performed of 90 patients with medically refractory UC who underwent STC with end ileostomy at The Mount Sinai Medical Center from 2002 to 2007. Patients with toxic megacolon were excluded. Univariate analysis was conducted by unpaired Student t-test and chi-square test. Results are presented as mean +/- 95% confidence interval.
  
  
  RESULTS
  Ninety patients underwent STC, 29 by laparoscopic and 61 by open approach. In patients undergoing laparoscopic versus open STC, intraoperative blood loss was decreased (130.4 +/- 38.4 vs. 201.4 +/- 43.2 ml, p < 0.05) and operative time prolonged (216.4 +/- 20.2 vs. 169.9 +/- 14.4 min, p < 0.01). In the absence of postoperative complication, hospital length of stay (4.5 +/- 0.7 vs. 6 +/- 1.3 days, p < 0.001) was shorter in laparoscopic versus open group. No mortalities occurred. Overall morbidity, 30-day readmission, and reoperation were equivalent regardless of operative approach. Wound complications were absent in the laparoscopic group compared with 21.4% in the open group (p < 0.01). Follow-up at a mean of 36 months demonstrated no difference in restoration of gastrointestinal continuity.
  
  
  CONCLUSIONS
  Laparoscopic STC confers the benefits of improved cosmesis, reduced intraoperative blood loss, negligible wound complications, and shorter hospital stay. Laparoscopy is a feasible and safe alternative to open STC in patients with UC refractory to medical therapy requiring urgent or emergent operation.
authors.affiliation: Department of Surgery, The Mount Sinai Medical Center, 1010 Fifth Avenue, New York, NY 10128, USA.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Vine
authors.forename: Garry
authors.initials: G
authors.lastname: Swain
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
authors.forename: Barry
authors.initials: B
authors.lastname: Salky
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Greenstein
authors.forename: Michael
authors.initials: M
authors.lastname: Harris
authors.forename: L Brian
authors.initials: LB
authors.lastname: Katz
mesh_terms: D000328:Adult; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome