Laparoscopic first-stage subtotal colectomy for ulcerative and indeterminate colitis: a propensity-matched study

Subtotal colectomy with end ileostomy is standard when medical therapy fails in ulcerative (UC) and indeterminate colitis (IC). However, the isolated safety profile of laparoscopic colectomy separate from restorative pouch surgery remains under-defined. We compared perioperative outcomes of open versus laparoscopic first-stage subtotal colectomy using propensity score matching (PSM).

Patients undergoing first-stage subtotal colectomy for UC/IC between 2005 and 2025 were evaluated. A 1:1 nearest-neighbor PSM balanced baseline characteristics, acuity, and medication exposure. Multivariable penalized logistic regression identified predictors of major complications (Clavien-Dindo ≥ III) and conversion, adjusting for surgical era.

Matching yielded 372 pairs (N = 744). Operative time was longer with laparoscopy (225 vs. 150 min, p < 0.001), but GI recovery was faster (first stoma output 2 vs. 3 days, p < 0.001) and hospital stay shorter (6 vs. 7 days, p = 0.005). Overall morbidity (27.4% vs. 25.5%, p = 0.618), major complications (7.3% vs. 4.6%, p = 0.161), and 30-day mortality (0.5% vs. 0.5%) were equivalent. Reoperations were more frequent after laparoscopy (5.1% vs. 1.3%, p = 0.006), driven by early diagnostic re-laparoscopy for washout/drainage (n = 7) and targeted hemostasis (n = 7). Surgical approach was not an independent predictor of major complications (OR 1.58, 95% CI 0.85-2.92; p = 0.149); age (OR 1.03/year, p = 0.006) and preoperative steroids (OR 2.28, p = 0.023) were independent drivers.

Laparoscopic first-stage subtotal colectomy was not associated with a statistically significant increase in major morbidity compared to open surgery.