Colectomy for ulcerative colitis is associated with short- and long-term complications.
Estimates of the frequency of such complications are variable and may have changed since the introduction of biological therapy.
Understanding the true burden of surgical complications is important to clinicians in assessing risks and benefits of colectomy vs. continued medical therapy.
Dr James Lindsay and colleagues from the United Kingdom ascertained the outcomes of colectomy and ileal pouch surgery in patients with ulcerative colitis in the biologics era.
The team searched Embase, MEDLINE and The Cochrane Library for studies reporting the outcomes of colorectal procedures in adults with ulcerative colitis.
Conferences proceedings were hand-searched.
|Late complications occurred in 17-55% of patients|
|Alimentary Pharmacology & Therapeutics|
The researchers identified 28 studies reporting outcomes from procedures conducted from 2002–2015.
The team found that early complications, reported in 10 studies, occurred in 9–65% of patients with ulcerative colitis, and late complications occurred in 17–55% of patients.
The research team observed that the most frequent short-term complications included infectious complications and ileus.
The team found that the most frequent long-term complications were pouchitis, faecal incontinence and small bowel obstruction.
Rates of early infection and late pouch failure decreased from 22% and 13% in 2002–2009 to 11% and 2% in 2010–2015.
The researchers noted that the mean incidence of post-operative mortality was 1% across 11 studies.
Dr Lindsay's team concludes, "Early and late complications arise in about one-third of patients undergoing surgery for ulcerative colitis."
"While colorectal surgical procedures are recommended for a specific group of patients, the post-operative complications associated with these procedures should not be underestimated."