title: Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre.
abstract: OBJECTIVE
  Subtotal colectomy (STC) is a well-established treatment for complicated and refractory ulcerative colitis (UC). A laparoscopic approach offers potentially improved outcomes. The aim of the study was to report our experience with STC for UC in a single large centre.
  
  
  METHODS
  From January 2007 to May 2015, all consecutive patients undergoing STC for UC were retrospectively analysed from a prospectively managed database. Patients with known Crohn's disease or those undergoing one-stage procedures were excluded. Demographics, perioperative outcomes and second-stage procedures were analysed.
  
  
  RESULTS
  During the study period, 151 STCs were performed for UC [100 emergency (66%) and 51 elective (34%)]. Acute severe colitis refractory to therapy was the most common indication (62%). Overall, 117 laparoscopic (78%) and 34 open STCs were performed, with a conversion rate of 14.5%. Mortality and morbidity rates were 0.7% and 38%, respectively. Whilst operative time was shorter for open STC (by 75 min; P = 0.001), there were fewer complications (32% vs 62%; P = 0.002) and a shorter hospital stay (by 6.9 days; P = 0.0002) following laparoscopic STC. Fewer complications and shorter hospital stay were also observed after elective STC. Patients undergoing laparoscopic STC were more likely to undergo a restorative second-stage procedure than those having open STC (75% vs 50%; P = 0.03).
  
  
  CONCLUSIONS
  Laparoscopic STC for UC is feasible and safe, even in the emergency situation. A laparoscopic approach may offer advantages in terms of lower morbidity and reduced length of stay. Elective resection may offer similar advantages and is best performed whenever possible.
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: N C
authors.initials: NC
authors.lastname: Buchs
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: A L A
authors.initials: ALA
authors.lastname: Bloemendaal
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: C P J
authors.initials: CPJ
authors.lastname: Wood
authors.affiliation: Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: S
authors.initials: S
authors.lastname: Travis
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Mortensen
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Guy
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: B D
authors.initials: BD
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ulcerative colitis; colectomy; complications; ileoanal pouch; laparoscopy; outcomes