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Session: ePoster: Benign Abdominal 7 (Mon1015)

EP683 - Laparoscopic Versus Open Total Abdominal Colectomy for Fulminant Clostridium Difficile Colitis

Monday, May 12, 2025
10:47 AM – 10:52 AM PT

    ePoster Presenter(s)

  • Matthew Laskovy, DO

    Colorectal Surgery Fellow
    Indiana University/Franciscan Health
    Camby, IN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • DP

    Daniel Peyser, MD

    Colorectal Surgery Fellow
    Indiana University
    Indianapolis, IN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • DM

    Dipen Maun, MD

    Program Director
    Indiana Colon and Rectal Specialists
    Indianapolis, Indiana, United States

    Disclosure information not submitted.

  • EF

    Evan K. Fitz, MD, FACS, FASCRS

    Colorectal surgeon
    Indiana Colon and Rectal Specialists
    Zionsville, Indiana, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Scott Dolejs, MD, MSc

    Colon and Rectal Surgeon
    Indiana Colon and Rectal Specialists
    Indianapolis, IN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Sanjay Mohanty, MD (he/him/his)

    Assistant Professor
    Indiana University School of Medicine
    Indiana University School of Medicine
    Indianapolis, Indiana, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Matthew Laskovy, DO: This individual has no financial relationships with ineligible companies.
Daniel Peyser, MD: This individual has no financial relationships with ineligible companies.
Scott Dolejs, MD, MSc: This individual has no financial relationships with ineligible companies.
Sanjay Mohanty, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Clostridium Difficile infection (CDI) is an increasingly common health care associated infection. Most patients are treated successfully with medical management. However, in patients with fulminant CDI who require surgery the most common approach is an open total abdominal colectomy (TAC) with end ileostomy. This is associated with substantial morbidity and mortality. The goal of our study is to determine if there is a benefit to approaching these highly morbid cases laparoscopically.

Methods/Interventions: The National Surgery Quality Improvement Program (NSQIP) database was queried from 2012-2021 for patients undergoing TAC for CDI. A retrospective analysis was performed using 1:1 propensity matching comparing laparoscopic vs open approach. The two groups were matched based on numerous preoperative variables including patient comorbidities and the presence/severity of preoperative sepsis. The primary outcome was 30-day postoperative morbidity, serious morbidity, and mortality. Secondary outcomes included total operative time.

Results/Outcomes: A total of 800 patients meeting our criteria were queried. After 1:1 propensity matching the overall sample size was 58 patients, with 29 in each of the laparoscopic and open groups. No statistically significant difference was found in terms of 30 day mortality (lap TAC 13.8% vs open TAC 20.7%, p=0.48), overall morbidity (lap TAC 60.1% vs open TAC 72.4%, p=0.71), or serious morbidity (lap TAC 51.7% vs open TAC 58.6%, p=0.60) between the two groups. There was however a significant difference in operative time between the two groups with median operative time of 221 mins in the lap TAC group and 132 mins in the open TAC group (p=0.0003).

Conclusion/Discussion: Both laparoscopic and open total abdominal colectomy are associated with tremendous morbidity and mortality in the treatment of fulminant CDI. There was no significant short-term morbidity or mortality benefit with a laparoscopic approach. However, there is a nearly 90 minute longer associated operative time for laparoscopic TAC. Laparoscopic TAC could be selectively considered in highly selected patients based on surgeon experience and patient stability, but an open approach should remain the default in most cases.