Management of Rectal Stump During Laparoscopic Subtotal Colectomy for Inflammatory Bowel Disease: A Comparative Cohort Study from Six Referral Centres. (11th March 2020)

• Record Type: Journal Article
• Authors: Mege, Diane; Stellingwerf, Merel E; Germain, Adeline; Colombo, Francesco; Pellino, Gianluca; Di Candido, Francesca; Maggiori, Léon; Foschi, Diego; Buskens, Christianne J; Adegbola, Samuel; Spinelli, Antonino; Warusavitarne, Janindra; Bemelman, Willem A; Sampietro, Gianluca; D'Hoore, André; Panis, Yves
• Is Part Of: Journal of Crohn's and colitis. Volume 14:Number 9(2020)
• Page Start: 1214
• Page End: 1221
• Publication Date: 2020-03-11
• Subjects: Subtotal colectomy -- laparoscopic ileal pouch-anal anastomosis -- rectal stump; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjaa046
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background and Aims: There is no consensus on the best management of the rectum after subtotal colectomy for refractory colitis complicating inflammatory bowel disease [IBD]. The objective was to evaluate the impact of rectal stump management during laparoscopic subtotal colectomy [LSTC] for IBD. Methods: Patients who underwent LSTC with double-end ileo-sigmoidostomy [Gr.A] or end ileostomy with closed rectal stump [Gr.B] for IBD were included from a retrospective database of six European referral centres. Results: In total, 314 patients underwent LSTC and were allocated to Gr.A [ n = 102] and B [ n = 212]. After LSTC, stoma-related complications occurred more frequently in Gr.A [12%] than in Gr.B [4%, p = 0.01]. Completion proctectomy with ileal pouch-anal anastomosis [IPAA] was performed as a three-stage procedure in all patients from Gr.A, and in 88 patients from Gr.B [42%; Gr.B1]. The other 124 patients from Gr.B underwent a modified two-stage procedure [58%; Gr.B2]. The second stage was performed laparoscopically in all patients from Gr.A compared with 73% of Gr.B1 [ p < 0.0001] and 65% of Gr.B2 patients [ p < 0.0001]. When laparoscopy was intended for 2nd stage IPAA, conversion to laparotomy occurred less frequently in Gr.A when compared with B1 [0 vs 5%, p = 0.06] or B2 [10%, p = 0.001]. When all surgical stages were included [LSCT and IPAA], cumulative stoma-related complications occurred more frequently in Gr.A [ n = 19] than in Gr.B1 [ n = 6, p = 0.02] and Gr.B2 [ n = 6, p = 0.001]. Conclusion: This study suggests that both techniques of double-end ileosigmoidostomy and end ileostomy with closed rectal stump are safe and effective for rectal stump management after laparoscopic subtotal colectomy.