SURGICAL TREATMENT OF ULCERATIVE COLITIS: 20-YEAR EXPERIENCE IN A REFERENCE CENTER

Introduction and Objectives Ulcerative colitis (UC) may be associated with an increased risk of hospitalizations and surgeries. Surgery is indicated in emergencies, for the treatment of severe refractory acute colitis, toxic megacolon, perforation, or enterorrhagia. It is also indicated in cases of treatment failure and in the presence of complications such as stenosis, severe dysplasia, and colorectal neoplasia. There is a scarcity of published data in Brazil regarding surgical treatment for UC. The objective of this study was to analyze the indications and frequency of surgical procedures performed over the past 20 years in patients with UC who underwent surgery at a public reference hospital.

Methods A retrospective analysis of the electronic medical records of UC patients who underwent surgery from 2002 to 2023 at a reference center. Surgical indications and clinical outcomes were evaluated, such as postoperative complications, reoperation rates, and mortality.

Results A total of 83 surgeries were performed, of which 62 (74.7%) were elective and 21 (25.3%) were urgent. Among the elective surgeries, the main indication was clinical intractability (n=55, 66.3%) and 9 cases of dysplasia or colorectal cancer (10.8%). Among the urgent surgeries, 13 patients (15.7%) underwent surgery for toxic megacolon/fulminant colitis and 6 cases (7.2%) for massive bleeding. The main surgeries performed included: total proctocolectomy with ileal reservoir (n=38, 45.8%), total colectomy with ileorectal anastomosis (n=25, 30.1%), partial colectomy (n=17, 20.5%), and total proctocolectomy with definitive ileostomy (n=3, 3.6%). Thirty-one patients (37.3%) required reoperation. The most common postoperative complications were anastomotic dehiscence (n=7) and stoma-related complications (n=6). Fifty-nine percent of patients had a definitive stoma. Half of the patients (n=38) who underwent total proctocolectomy with ileal reservoir had clinical and endoscopic signs of “pouchitis” (inflammation of the pouch). The reservoir loss rate was 6% (n=5). The mortality rate among operated patients was 2.4% (n=9).

Conclusion The mortality rate in UC patients undergoing surgical procedures was low. Total colectomy with or without ileorectal anastomosis and IPAA were the most commonly performed techniques. Partial colectomy is reserved for selected cases in elderly patients, with comorbidities, and with colitis in remission.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025