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: Supplement maker admits lying about ingredients

add to favorites email to friend print save as pdf

Related Stories

Fewer lectures, more group work

11 minutes ago

Professor Cees van der Vleuten from Maastricht University is a Visiting Professor at Wits University who believes that learning should be student centred.

Stranded pilot whale rescued in Cape Verde

11 minutes ago

The archipelago nation of Cape Verde is widely recognised as a marine biodiversity hotspot, not least because of the abundance of marine mammals found in its waters.

Protection of the mouse gut by mucus depends on microbes

11 minutes ago

The quality of the colon mucus in mice depends on the composition of gut microbiota, reports a Swedish-Norwegian team of researchers from the University of Gothenburg and the Norwegian University of Life Sciences in Oslo. ...

The Greenland Ice Sheet: Now in HD

20 minutes ago

The Greenland Ice Sheet is ready for its close-up. The highest-resolution satellite images ever taken of that region are making their debut. And while each individual pixel represents only one moment in time, ...

Recommended for you

Supplement maker admits lying about ingredients

15 hours ago

Federal prosecutors say the owner and president of a dietary supplement company has admitted his role in the sale of diluted and adulterated dietary ingredients and supplements sold by his company.

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.