Background: Medical treatment of severe acute colitis (SAC) complicating inflammatory bowel disease (IBD) is given in order to avoid surgery, but in 20 to 50% of cases colectomy remains necessary. This study aimed to determine the impact of the different lines of medical therapy (i.e. steroids, antiTNF or ciclosporin) on postoperative course after laparoscopic subtotal colectomy (LSTC) for SAC complicating IBD.
Methods: All the patients who underwent LSTC for SAC were included, and divided into 2 groups: those who presented with postoperative morbidity (Group A) and those with an uneventful course (Group B). Preoperative physical, endoscopic and radiological data, and medical treatment were compared between groups.
Results: From 2006 to 2015, 65 patients (32 males, median age =35 [17–87] years) operated for SAC were included. Postoperative morbidity occurred in 20 patients (31%, Group A), and was mainly represented by surgical morbidity (n=16), including ileus (n=10), stoma-related complications (n=8) and intra-abdominal abscess (n=5). Major morbidity was noted in 8/65 patients (12%). No mortality occurred in the two groups.
Number of previous episode of SAC, Lichtiger score, endoscopic and radiological evaluation were similar between groups. There was no significant difference between groups regarding preoperative steroid treatment alone (40 vs 29%, p=0.57), steroids with another immunosuppressive drug (40 vs 35%, p=1.00) or steroids with two other immunosuppressive drugs (10 vs 9%, p=1.00).
Conclusions: This study suggests that postoperative course after LSTC for SAC is not affected by any preoperative medical treatment.