Does aggressive medical therapy for acute ulcerative colitis result in a higher incidence of staged colectomy?
S. J. Ferzoco and J. M. Becker
Division of General and Gastrointestinal Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
BACKGROUND: Colectomy with ileal pouch-anal anastomosis is the operation of
choice in patients with medically refractory ulcerative colitis. However,
aggressive or prolonged medical treatment may result in the patient's
needing an urgent operation in which a staged subtotal colectomy is
necessary. OBJECTIVE: Our hypothesis is that the incidence of patients
requiring a staged approach has increased, along with an increase in
hospital stay and total hospital costs. DESIGN: We examined the medical
records of 250 consecutive patients with ulcerative colitis who underwent
ileal pouch-anal anastomosis between 1984 and 1993. RESULTS: Simultaneous
colectomy and ileal pouch-anal anastomosis were performed in 196 patients
(78%), while 54 patients (21.6%) required staged subtotal (78%) or partial
colectomy (22%). Indications for initial colectomy included failure of
medical therapy (42 patients [77.8%]), undifferentiated colitis (five
patients [9.3%]), and perforation (six patients [11.1%]). An increase in
the incidence of patients requiring staged colectomy during this period was
observed (P < .05). Staged procedures led to a prolonged hospital course
at a significantly greater total cost. CONCLUSION: We conclude that
aggressive medical therapy of acute ulcerative colitis has increased the
incidence of urgent staged colectomy with a resulting increase in
morbidity, hospital stay, and cost and a less-optimal functional result.
