PTU-086 Outcomes of all surgery for ulcerative colitis over a 12-month period at a tertiary referral ibd unit

Introduction 1/4 of patients with ulcerative colitis (UC) will require surgery. We describe an audit of indications and outcomes of UC surgery at LTHT a tertiary referral centre for pouch surgery. Method Patients undergoing surgery for UC in 2013 were identified from surgical lists, IBD nurse post-op review and from histopathology database. Data were extracted from electronic records and case notes. Results 42 cases, 38 with complete dataset, 25 (59.5%) males. Mean age 42 (range 18-91), mean age at diagnosis 33 (7-68). 21 (55%) had failed >3 therapies and 15 (39%) taking oral steroids at time of surgery. 0 E1 disease, 15 (39.5%) E2, 15 (39.5%) extensive colitis (E3), 8 (21%) extent unclear. 48 procedures on 38 patients within the 12 months, 32 (67%) were elective, 16 (33%) emergency. Of 16 emergencies 11 were sub-total colectomies for acute severe disease (5 open, 6 laparoscopic), 3 EUAs, 1 rectal stump dehiscence and 1 obstructing tumour. At 12 months 23 (61%) completed pouch surgery. Of 40 colectomies 27 (67.5%) were laparoscopic. Indications: failed medical therapy 78.9% (n = 30, one low grade dysplasia), cancer 7.9% (n = 3, 1 = panproctocolectomy transverse colon carcinoma, 1 = pouch with adenocarcinoma cuff, 1 = sub-total colectomy with tumour in rectal remnant), patient choice 5.3% (n = 2), perforation 2.6% (n = 1), other 5.3% (n = 2) One death from pneumonia following emergency procedure. 11 short-term complications in 7 patients having 2-stage pouch surgery (5 wound infections, 2 anastomotic leaks, 1 ileus, 1 chest infection, 1 failure to restore continuity, 1 ureteric damage). 5 had longer-term complications (1 each for pouch dysfunction, high output stoma, strictured anastomosis, pouchitis, peri-anal pain). 7/16 having 3-stage pouch suffered one or more short-term complications (5 wound infection/dehiscence, 5 intra-abdominal complication (collection/sepsis/bleed), 2 ileus and one each of anastomotic leak, chest sepsis, VTE, rectal stump complication, AKI, confusion, pneumaturia, anterior spinal artery infarct). 7/16 patients suffered one or more longer-term complication (3 high output stoma before reversal ileostomy, anaemia n = 2 and and 1 of rectal discharge, SBO, adrenal insufficiency and retrograde ejaculation) Conclusion Leeds is a high volume surgical unit performing 23 pouch operations in 12 months compared with the median number of 4 (national IBD audit). Most were laparoscopic as recommended by the IBD service standards. Pouch surgery c