Subtotal colectomy in ulcerative colitis-long term considerations for the rectal stump

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Oncology

Background:

• Subtotal colectomy with end ileostomy is a common initial surgery for ulcerative colitis.
• Some patients do not undergo completion proctectomy, leaving a rectal stump.
• The rectal stump poses long-term risks and requires surveillance.

Purpose of the Study:

• Review literature on long-term complications of rectal stumps.
• Outline surgical management options for remnant rectum and anal canal.
• Develop guidelines for endoscopic screening in this patient cohort.

Main Methods:

• Systematic review of PRISMA-guided literature on rectal stump endoscopy surveillance.
• Secondary narrative review of medical and surgical management options for retained rectum.

Main Results:

• Surveillance intervals varied: 6-12 months (20%), yearly (50%), bi-yearly (10%), risk-stratified (30%).
• Endoscopy with biopsy is universally recommended for surveillance.
• Surgical management options for the remnant rectum were identified.

Conclusions:

• Endoscopic surveillance of the rectal stump is crucial, guided by risk stratification.
• Careful endoscopic technique is vital to prevent rectal perforation and pelvic sepsis.
• Intersphincteric dissection is favored for anal canal removal during completion proctectomy.