Systematic Review : The Burden of Post-Operative Complications Following Colectomy for Ulcerative Colitis

Abstract

Background: Ulcerative colitis (UC) patients failing medical management require colectomy. Methods:Literature search in MEDLINE , CINAHL and Embase, targeting studies reporting the outcomes of colorectal procedures (from 2002 to 2016 with total and subtotal colectomy postoperative complications in adults with ulcerative colitis as an endpoint. Texts and authoritative Web sites were also reviewed then identification of papers according to the inclusion and exclusion criteria and data extraction were performed by two independent researchers. Results:Following data extraction and synthesis, we identified 24 articles for review. Reporting outcomes from procedures conducted from 2002–2016. Most frequent short-term complications: infectious complications and ileus (mean incidence 21% and 19%), while most frequent long-term complications: pouchitis, fecal incontinence and small bowel obstruction (mean incidence 31%, 22% and 18%). Post-operative early complications (≤30 days) occurred in 18–63% of patients with ulcerative colitis while late complications (>30 days) occurred in 19–58% of patients. Rates of early infection and late pouch failure decreased significantly from 2002 to 2015 (22% to 2% respectively). Conclusion:although Colectomy remains an appropriate therapeutic strategy for specific groups of patients- it is not the optimal cure for UC. Clinicians need to fully understand the various postoperative complications and comorbidities that are highly prevalent with over a third of patients expected to experience long-term or late arising post-operative complications. Thus, while surgical procedures are recommended as an appropriate therapeutic strategy for a specific group of patients, the post-operative complications associated with these surgical procedures should not be underestimated.