Threshold for bowel surgery may be too high, warn experts

Oct 31, 2007

The clinical threshold for undertaking elective surgery to remove part or all of the colon (colectomy) for people with inflammatory bowel disease (IBD) may be too high, warn researchers in a study published on bmj.com today.

IBD is a general term for chronic inflammation of the intestine and includes ulcerative colitis and Crohn’s disease. Around a quarter of a million people in the UK are affected and many people will require colectomy at some stage. Currently there are about 2,000 total or partial colectomies performed each year in England for IBD.

Death rates following elective colectomy are typically quite low, at least in the short term, while delaying surgery carries increased risks. It is thought, increasingly, that the thresholds for elective colectomy may be too high. However, there is a lack of strong evidence about this.

So researchers from Swansea and Oxford used routinely collected hospital data throughout England to investigate mortality after colectomy for IBD, comparing those who underwent elective colectomy, emergency colectomy, or who were hospitalised for IBD but had no colectomy. The study included 23, 464 people who were hospitalised for more than three days for IBD, 5,480 of whom underwent colectomy, and traced all deaths up to three years after hospital admission.

They found improved long term survival for elective colectomy compared with emergency colectomy or no colectomy. The findings also confirmed a substantially increased risk of dying shortly after emergency colectomy.

At three years, the increased of risk of death in people who did not undergo colectomy was almost as high as that in people who underwent emergency colectomy. In contrast, survival among people who underwent elective colectomy was very similar to that in the general population.

Our study findings suggest that the threshold for elective colectomy for IBD in England is too high, say the authors.

It also illustrates that, whenever indicated and possible, it is preferable for colectomy to be undertaken electively, rather than risk the need for emergency surgery when it has a much poorer prognosis.

They believe that further research is now required to establish the threshold criteria and optimal timing for colectomy in people with poorly controlled IBD.

The idea that surgery for IBD should be the last resort is flawed, adds an accompanying editorial. These findings, even allowing for interpretation, should be a word of caution to those who promote it.

Source: British Medical Journal

Explore further: Cambodia bans 'virgin surgery' adverts

add to favorites email to friend print save as pdf

Related Stories

Orangutans take the logging road

10 minutes ago

A new discovery by a Simon Fraser University doctoral student in the School of Resource and Environmental Management, published in Oryx, demonstrates that orangutans may be even more adaptable than he fir ...

Long dry spell doomed Mexican city 1,000 years ago

1 hour ago

Archaeologists continue to debate the reasons for the collapse of many Central American cities and states, from Teotihuacan in Mexico to the Yucatan Maya, and climate change is considered one of the major ...

Recommended for you

Why aren't there any human doctors in Star Wars?

5 hours ago

Though set "a long time ago in a galaxy far, far away," it isn't hard to see in the Star Wars films a vision of our own not so distant future. But Anthony Jones, a physician with a long background in health ...

Cambodia bans 'virgin surgery' adverts

Jan 29, 2015

The Cambodian government has ordered a hospital to stop advertising so-called virginity restoration procedures, saying it harms the "morality" of society.

What's happening with your donated specimen?

Jan 28, 2015

When donating blood, plasma, human tissue or any other bodily sample for medical research, most people might not think about how it's being used. But if you were told, would you care?

Amgen tops Street 4Q forecasts

Jan 27, 2015

Amgen Inc. cruised to a 27 percent jump in fourth-quarter profit and beat Wall Street expectations, due to higher sales of nearly all its medicines, tight cost controls and a tax benefit.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.