Evaluation of indications for Colectomy in IBD Patients

Abstract

Colectomy in IBD may be necessary in several conditions, the main cause being the acute severe colitis (ASC). The aim of this work is to study the role of surgery in the management of IBD, in particular colectomy, and to determine its main indications. This is a retrospective study conducted over a 5-year period from July 2018 to July 2023 involving 424 patients followed up for IBD. We included in our study patients of both sexes, with documented Crohn’s disease (CD) or ulcerative colitis (UC) and who benefited from colectomy, we excluded patients whose follow-up could not be ensured. Of the 45 patients (10.61%) colectomized, the mean age at colectomy was 35 years [18-56], the predominance was female with an F/H sex ratio of 1.25, 34 patients had UC (75.5%) and 11 followed for CD (24.5%). The main indication for surgery was corticoresistant ASC in 31 patients (46.5%). Other indications were: 5 strictures (11.1%), 4 occlusions (8.8%), 3 colonic fistulas (6.6%) and 2 abscesses (4.4%). There were no immediate postoperative deaths. Anastomotic leakage occurred in 4 patients (8.8%) and small bowel stenosis in 2 patients (4.4%). In patients with CD, the flare-up subject to surgery was inaugural in 2 patients (18.18%); the mean period between the onset of symptoms and surgery was 3 years and 2 months. In the case of UC, 10 patients (29.41%) had a flare-up at the start of surgery, with an average delay of 6 years and 1 month. At follow-up, 5 patients (11.1%) had a recurrence or exacerbation of the disease. This was the most frequent indication for a subsequent protectomy or permanent ileostomy during the follow-up period. Collaboration between the gastroenterologist and the surgeon is essential to recognize the optimum time to propose surgery, so as not to increase patient morbidity and mortality.