EP824 - Open Total Abdominal Colectomy for Ulcerative Colitis in the Era of Minimally Invasive Surgery: Obsolete or Necessary Evil?

ePoster Presenter(s)

• EH

  Enda Hannan, MD MS FRCSI

  Colorectal Fellow
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Author(s)

• 

  Christopher Prien, MD, MS

  Colorectal Surgery Fellow
  Cleveland Clinic
  Cleveland Clinic
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• OL

  Olga Lavryk, MD, PhD

  Staff, IBD Surgery Section
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Anuradha R. Bhama, MD

  Associate Professor
  Cleveland Clinic
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Jeremy M. Lipman, MD (he/him/his)

  Director of Graduate Medical Education
  Cleveland Clinic Foundation
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Hermann Kessler, MD PhD (he/him/his)

  Professor
  Cleveland Clinic
  Cleveland Clinic
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Michael A. Valente, DO

  Associate Professor of Surgery
  Cleveland Clinic
  cleveland, Ohio, United States

  Disclosure information not submitted.
• Ad

  Anthony de Buck van Overstraeten, MD, MSc

  Colorectal surgeon
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Stefan D. Holubar, MD, MS, FACS, FASCRS

  Professor of Surgery; Director of Research
  Cleveland Clinic
  Case Western Reserve University
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Purpose/Background: Minimally invasive (MIS) total abdominal colectomy for medically refractory ulcerative colitis (UC) has become the standard of care. The role of open TAC in the MIS era has not been evaluated. We aimed to describe the short-term outcomes of open vs. MIS TAC for medically refractory ulcerative colitis, and to evaluate the impact of surgical approach on subsequent operations such as restorative or completion proctectomy. We hypothesized that open compared with MIS TAC is associated with increased short-term morbidity in the modern era.

Methods/Interventions: A retrospective analysis of a prospectively maintained database of all patients who underwent TAC and end ileostomy formation for UC over a 10-year-period (2015-2025) in a quaternary referral center was performed. Demographic, perioperative and postoperative outcomes of both approaches were compared. Univariate analysis compared baseline characteristics and short-term (30-day) outcomes between groups.

Results/Outcomes: A total of 413 patients were analyzed, 357 (86%) MIS and 56 (14%) open. A greater proportion of patients in the open than the MIS group underwent emergent surgery (41.1% vs. 1.7%, < 0.001). The indications for open TAC included patient hemodynamic instability (16.1%, n=9), perforation (12.5%, n=7), obstruction (7.1%, n=4), toxic megacolon (7.1%, n=4), prior abdominal surgery (10.7%, n=6) and surgeon discretion (12.5%, n=8). Preoperative albumin was significantly lower in those who underwent open surgery (2.9 vs 3.7, p=0.03). The post-operative length of stay (7 days vs 4 days, p=0.04), opioid utilization on discharge (16.1% vs 0.8%, p< 0.001), superficial surgical site infection rates (37.5% vs 12.3%, p< 0.001) and overall postoperative complication rates (46.4% vs 23.8%, p< 0.0014) all favored MIS TAC. Unplanned reoperation was similar following open TAC compared MIS groups (8.9% vs. 6.4%, p=0.4), most of which were for postoperative bowel obstruction or ileostomy-related complications. The 30-day postoperative mortality rate was similar after open and MIS TAC (1.7% vs. 0.8%, p=0.5). Subsequent completion proctectomy was performed at a similar rate in the open and MIS TAC group (66.1%, n=37 vs. 71.1% n=254, p=0.4); of these, 64.8% (n=24) and 68.1% (n=173) were IPAA, respectively (p=0.7). The MIS TAC patients underwent completion proctectomy or IPAA formation 44 days sooner than those following open TAC (p < 0.001).

Conclusion/Discussion: In the era of minimally invasive surgery, we observed that approximately 15% of ulcerative colitis patients required open surgery, most commonly for emergent indications. Not surprisingly, patients who underwent open surgery experienced a significantly higher rate of postoperative morbidity but similar mortality. Clearly, an open approach to total colectomy for ulcerative colitis still plays an important role in the era of minimally invasive surgery where clinically appropriate.

Table 2. Short-term (30-day) outcomes after total abdominal colectomy for ulcerative colitis, 2015-2025 (N=413).
Figures represent median (interquartile range) or frequency (proportion).