EP563 - Safety Of Segmental Resection For Ulcerative Colitis In The Biologic Era.

Sunday, May 10, 2026

2:46 PM - 2:51 PM ET

Senior Author(s)

Richard Fortunato, D.O. (he/him/his)

Program Director, Colon and Rectal Surgery Fellowship
ALLEGHENY HEALTH NETWORK
Drexel University College Of Medicine
Pittsburgh, Pennsylvania, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

ePoster Presenter(s)

Bigyan Mainali, MD

Colorectal Surgery Fellow
Allegheny Health Network
Allegheny General Hospital
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.

View ePoster

Author(s)

Selim Gebran, MD

Colorectal Fellow
Allegheny Health Network
Drexel University
Pittsburgh, PA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
JM

James McCormick, Professor, Surgery, Drexel University College of Medicine

Chair, Colorectal Cancer Center of Excellence, AHNCI
ALLEGHENY HEALTH NETWORK, Drexel University College of Medicine
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.

Purpose/Background: One third of patients with ulcerative colitis (UC) ultimately require surgical intervention, with surgical treatment primarily being a total abominal colectomy with permanent ileostomy or proctocolectomy with or without ileal-anal pouch anastomosis. Segmental resections have traditionally been avoided due to concerns for surgical complications and disease recurrence. Advancements in medical management have led to exploration of organ-preserving surgical options for selected pathology in patients with UC. We aimed to assess the surgical safety and long-term results of segmental resection performed at our tertiary-care academic institution.

Methods/Interventions: We reviewed records of patients who underwent total abdominal colectomy with ileorectal anastomosis or a segmental resection with or without anastomosis for UC between 2018 and 2024. Patients with endoscopic or pathologic findings of Crohn's disease were excluded. Data included patient demographics, disease characteristics, operative details, and outcomes. The primary endpoint was thirty-day morbidity (Clavien-Dindo ≥3b). Secondary endpoints included reoperation for disease relapse, postoperative biologic therapy use, and permanent stoma rates. A disease-free survival Kaplan-Meier plot was made based on the time-dependent determination of the first disease relapse after segmental resection.

Results/Outcomes: Among 238 total colectomies for ulcerative colitis performed during the study period,

28 patients (12%) received a segmental resection, of which the majority were male (61%, n=17). The most common operative indication was cancer/ dysplasia/ pseudopolyposis (39%, n=11), followed by severe colitis refractory to medical therapy (25%, n=7). In 82% of patients (n=23/28) an anastomosis was performed (ileorectal 57%, colorectal 17%, colocolonic 13%, and ileocolic 9%). Overall, 30-day morbidity occurred in 18% of all patients (n=5/28) with an 8% anastomotic leak rate (n=2/23). There were no mortalities. At last chart follow-up (median 28 months, IQR 9-46), 79% of all patients did not require a reoperation or postoperative biological therapy (n=22/28), and 78% of patients who had an anastomosis remained ostomy free (n=18/23).

Conclusion/Discussion: Our findings suggest that in carefully selected UC patients, organ-preserving segmental resection with or without an anastomosis can be a safely performed with low short-term morbidity and promising long-term outcomes.

Patient Characteristics and Outcomes

UC Disease-free Survival