High Rate of Complications from Colectomy for Ulcerative Colitis

Twenty-seven percent of patients who are treated for ulcerative colitis by colectomy experience postoperative complications, according to a study in the November issue of Clinical Gastroenterology and Hepatology.

Most patients with ulcerative colitis are successfully treated with medication, yet some have severe colitis attacks that can be life threatening. Approximately 10% of patients with colitis therefore receive a colectomy (surgical removal of all or part of the colon) within the first 10 years of diagnosis. However, it is not clear how many people experience complications from this surgery, or what the risk factors are.

Shanika De Silva et al. performed a population-based study to determine the occurrence and severity of postoperative complications and identify factors that affect outcome.

Analyzing 14 years of data, from 666 patients with ulcerative colitis who received colectomies, the authors found that a postoperative complication occurred in 27.0% and the mortality rate was 1.5%. The risk for complications was greatest among patients more than 64 years or with other health complications, such as a history of cardiac disease.

Furthermore, patients with colitis who were admitted to the hospital under emergency conditions and did not respond to medical treatment had worse outcomes when surgery was performed 14 or more days after admission. Patients who underwent emergent surgery because they did not respond to in-hospital medical management, or developed an acute complication, had worse outcomes (2.4% mortality) than patients who had elective surgeries.

Patients who receive immunosuppressants or other drugs for inflammatory bowel diseases (mesalamine, corticosteroids, azathioprine, 6-mercaptopurine, or infliximab) do not have an increased risk for postoperative complications, including infections. Institutions that performed less than 4 colectomies in patients with ulcerative colitis per year had 2-fold greater postoperative mortality than high-volume hospitals that performed surgery on greater than 12 patients per year.

De Silva et al. conclude that it is important to carefully select patients for colectomies. Elderly patients and those with other diseases should be offered comprehensive medical management, and other strategies should be considered before colectomy.

The authors state that elective colectomies have the best outcomes, so gastroenterologists and surgeons should try to optimize management of patients, making timely decisions for surgery in the outpatient setting.

More Information on Colectomy:

Read the article online.
De Silva S, Ma C, Proulx M-C, et al. Postoperative complications and mortality following colectomy for ulcerative colitis. Clin Gastroenterol and Hepatol 2011; 9:972–980

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About Kristine Novak, PhD, Science Editor

Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology, both published by the American Gastroenterological Association. She has worked as an editor at biomedical research journals and as a science writer for more than 12 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.
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4 Responses to High Rate of Complications from Colectomy for Ulcerative Colitis

  1. Dr.Chohn's says:

    I always love this post I love being aware of the disease

  2. Mike S. says:

    I had a total colectomy(from a bad case of UC)about 7 years ago and still have numerous bowel movements(15 a day is a good day). Consequently, I suffer from extreme irritation in and around my rectum(severe burning and itching). Everything I eat seems to affect me…even the good stuff..Anybody else have this problem? Any suggestions? Thanks for listening

    • Greg says:

      Opiates for diarrhea are indicated (I’m exact same as you), finally got a Gastro to let me try tincture of opium (after having taken opiate pain meds due to that irritation becoming a anal fissure – I wiped too hard, was trying to gain weight so over-trained, over-wiped, over-ate, over-pooped = the spotting blood became a fissure. Sad because I had no idea that was possible, thought it would just heal as usual with sleep). Fissure/cut took 3 months to heal, worst pain you can imagine – just don’t ever get a cut down there. I’ve had 3 total since I was 25 despite being more careful using baby wipes and now lotion on the tp, or baby no tears soap). I had UC at age 7, 3 flare-ups, total colectomy age 16, never could gain weight, over did it at age 25 and found my weak spot. Sadly, Dr.’s are so averse to opiates in general these days its been a whole other hell just trying to get a Dr. to prescribe and effectively manage the opiates (codeine or tincture of opium are indicated for diarrhea refractory to basics like imodium and such). I’ve found that the chronic-diarrhea we j-poucher’s experience is not sufficiently addressed, minimized (we also end up with nutrient deficiencies such as b-12/iron so get that checked out). As soon as I began taking the opiates for pain from the fissure I noted that my bowel sounds, cramps, and BM’s per day were magically lessened. I looked it up and discovered that Dr.’s and science are fully aware of the effectiveness and use of opiates for surgically induced chronic-diarrhea (I’m not blaming so much because I never saw any Dr.’s in the 15 years after my colectomy, didn’t think I needed to, didn’t realize they may have prescribed opiates (had I come across one that didn’t put his/her fears of the DEA above my health and ability to sleep through the night, absorb nutrients/water/electrolytes/minerals/b-12, etc., remain pain free of excoriation ‘butt-burn’, regain my social life and lose my anxiety (loud gassy poops at your friends houses?). Anyway, look into it. I’m going to write a short book for those of us who are post-colectomy, fill in the blanks where the Dr.’s are either ignorant (not to blame really), misinformed, etc. If you want to keep in touch, here I am http://www.facebook.com/homeSlice187 (if you can get a Gastro to prescribe codiene or tincture, have them refer you to a pain management dr. they should work together and manage the inevitable tolerance and dependence – beware of addiction, lowered inhibitions, etc. if you’ve never taken it. If you can work with your Dr.’s and keep your head, the side-effects go away quickly yet the constipating effect remains much longer. Just be careful, this is why you need to work with a Gastro who has experience with such medications. Ask for the oldest, most experienced Gastro you can find. :)

  3. stephen g says:

    I had a colectomy about 12 years ago and things have never quite settled down. I have just started a fodmap diet and whilst I have not noticed any great frequency change it has helped with bloating, bad breath and general Wellness so I plan on persisting with it. In terms of a painful backside I suggest using vaseline and putting a piece of folded gause between the bum cheeks – not too pleasant but my surgeon told me this and it has helped with itching and soreness – also baths with salt water in them. Good luck.

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