Premium
Systematic review of rectal stump management during and after emergency total colectomy for acute severe ulcerative colitis
Author(s) -
Bedrikovetski Sergei,
DudiVenkata Nagendra,
Kroon Hidde M.,
Liu Jianliang,
Andrews Jane M.,
Lewis Mark,
Lawrence Matthew,
Sammour Tarik
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15075
Subject(s) - medicine , total colectomy , ulcerative colitis , colectomy , surgery , mortality rate , sepsis , general surgery , disease
Background There is no consensus about the optimal management of the rectal stump after an emergency subtotal colectomy in patients with acute severe ulcerative colitis (ASUC). The aim was to perform a systematic review of the published literature on the surgical and medical management of the rectal stump after an emergency (sub) total colectomy in patients with ASUC. Methods The following databases were searched, MEDLINE (PubMed), EMBASE and OVID SP, from January 1993 to March 2018. Studies that reported post‐operative outcomes after surgical and/or medical management of the rectal stump after emergency (sub) total colectomy in adults with ASUC were included. Two independent assessors reviewed eligible articles. Results A total of 11 studies met the inclusion criteria. All were case series and included 476 patients. Regarding surgical management, five studies reported on closed subcutaneous placement of the rectal stump, seven on intraperitoneal placement and two on the formation of a formal mucous fistula. The lowest reported pelvic sepsis rate was in patients with subcutaneous closure of the rectal stump ( n = 144, 2%) and lowest wound infection rate was reported after intraperitoneal closure ( n = 268, 7.8%). The highest rate of mortality was reported after intraperitoneal placement of the rectal stump ( n = 268, 1.5%). There were insufficient data reported on medical management for any comparison. Conclusion Subcutaneous placement of the rectal stump was associated with the lowest morbidity and mortality rate, although data are of limited quality and insufficient to guide practice recommendations.