Premium
Colectomy with ileorectal anastomosis has a worse 30‐day outcome when performed for colonic inertia than for a neoplastic indication
Author(s) -
Reshef A.,
Gurland B.,
Zutshi M.,
Kiran R. P.,
Hull T.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12058
Subject(s) - medicine , colectomy , incidence (geometry) , surgery , body mass index , gastroenterology , ileus , rectum , demographics , anastomosis , inflammatory bowel disease , ulcerative colitis , disease , physics , demography , sociology , optics
Aim Whether bowel related dysfunction adversely affects postoperative recovery after total colectomy with ileorectal anastomosis ( C + IRA ) for colonic inertia ( CI ) has not been previously well evaluated. This study compared the early postoperative outcome of C + IRA for CI and for other noninflammatory indications. Method Patients undergoing elective C + IRA from 1999 to 2010 were identified from a prospectively maintained database. Since inflammation in the rectum or small bowel may influence the outcome, patients with inflammatory bowel disease were excluded. Patients undergoing surgery for CI (group A ) were compared with patients having the operation for other benign noninflammatory diseases (group B ). Demographics, A merican S ociety of A nesthesiologists ( ASA ) score, body mass index ( BMI ), surgical procedure and 30‐day complications were assessed. Results The study population consisted of 333 patients undergoing elective C + IRA (99 men, mean age 39 ± 16 years). The procedure was laparoscopic in 163 (49%) patients. Groups A ( n = 131) and B ( n = 202) had similar age and ASA score (39 ± 11 vs 39 ± 19 years, P = 0.4; 2.2 ± 0.5 vs 2.4 ± 0.7). Group A patients had lower BMI (25 ± 5 vs 28 ± 8 kg/m 2 , P = 0.002), more women (99 vs 51%, P < 0.001) and fewer laparoscopic procedures (43 vs 53%, P = 0.04). Compared with group B , group A had a greater incidence of postoperative ileus (32 vs 19%, P = 0.009), higher overall morbidity (36 vs 15%, P < 0.001) and increased length of stay (8.4 ± 6 vs 7.2 ± 5 days, P < 0.006). These differences persisted when subgroups of patients who underwent laparoscopic or open surgery were compared. Conclusion Although CI is considered a ‘benign’ condition, patients undergoing C + IRA for this indication have significant morbidity compared with patients having the operation for other noninflammatory benign conditions.