Rectal Stump Management After Subtotal Colectomy for Severe Colitis, In or Out? A Retrospective Cohort Study

Abstract

There is little evidence to guide optimal medical and surgical management of the rectal stump in patients undergoing subtotal colectomy (STC) for severe colitis (SC) and acute severe ulcerative colitis (ASUC). All patients undergoing an STC for SC and ASUC at the Royal Adelaide Hospital (RAH), Australia, between 1993 and 2018 were identified and included from the RAH inflammatory bowel disease database and hospital records. Patient demographics, postoperative medical and surgical outcomes, and second-stage procedures were analyzed. Sixty-one patients underwent an STC for SC including ASUC. In 21 patients, the rectal stump was left in situ, whereas in 40, the rectal stump was extra-fascial. Thirty-five of the 61 patients underwent surgery for ASUC, of whom 10 were in the in situ group and 25 in the extra-fascial group. Baseline patient characteristics were similar, except for a significantly higher American Society of Anaesthesiologists score (P 0.024) in the extra-fascial ASUC group. There were no statistically significant differences in the postoperative outcomes between the extra-fascial group and the in situ group for SC and ASUC. There was, however, a trend toward lower rates of systemic sepsis (1 (4%) vs 3 (30%), P 0.061) and pelvic sepsis (1 (4%) vs 2 (20%), P 0.190) in the extra-fascial compared with the in situ group in the ASUC subset. In our experience, exteriorization of the rectal stump after STC for ASUC may confer a lower systemic and pelvic sepsis rate compared with the in situ group; however, better powered prospective studies with larger numbers are required to confirm this.