Urgent subtotal colectomy for ulcerative colitis: a Modified Delphi e-consensus on behalf of the Italian Society of Colorectal Surgery (SICCR)
Year: 2026
Type: article
Abstract: Acute severe ulcerative colitis (ASUC) affects up to 25% of patients with ulcerative colitis, with 20–40% ultimately requiring urgent subtotal colectomy. Despite established guidelines on the medical management of ASUC, current recommendations from guidelines do not address the procedural and technical aspects of the operation itself. Significant variability in surgical practice has been documented even among high-volume Italian inflammatory bowel disease (IBD) centers. A national e-consensus was conducted using a modified Delphi method. Fifteen expert colorectal surgeons members of Italian Society of Colorectal Surgery (SICCR) from 15 high volume IBD surgical Units (13 Italian, 2 international) evaluated 14 statements across four procedural domains. Each statement was rated on a 4-point ordinal scale (1 = full agreement; 4 = disagreement). Statements achieving > 75% full agreement or ≥ 80% combined full agreement + agreement were classified as appropriate. Uncertain statements were revised and resubmitted for a second voting round. In the first round, 8 of 14 statements achieved consensus; 6 were classified as uncertain and revised for resubmission. All six revised statements achieved consensus in the second round. The final document comprises 11 consensus statements addressing: management of the rectal stump and drainage (5 statements), role of the greater omentum (1 statement), laparoscopic versus open surgical approach (3 statements), and management of the mesocolon (2 statements). This e-consensus provides the first structured, evidence-graded procedural guidance for urgent subtotal colectomy in acute severe ulcerative colitis (ASUC), covering technical aspects not addressed by current international guidelines. These recommendations aim to reduce practice variability and support standardized surgical decision-making across IBD centers.
Source: Techniques in Coloproctology
Authors: F. Sacchetti, V. Bellato, F. Carannante, G. Tomasicchio, D. Passannanti, A. Picciariello, C. Nesci, M. Cricrì, G. Calini, G. T. Capolupo, S. Scaringi, G. Barugola, I. Angriman, M. Carvello, V. Celentano, F. Colombo, F. Selvaggi, G. Luglio, M. Rottoli, G. Sampietro, F. Ferrara, G. Pellino, A. Spinelli, L. Sofo, R. Pietroletti, P. De Nardi, M. Mineccia
Institutions: Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, University of Rome Tor Vergata, Policlinico Tor Vergata, Università Campus Bio-Medico, Campus Bio Medico University Hospital, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Azienda Ospedaliera Bolognini Seriate, University of Salento, Federico II University Hospital, University of Naples Federico II, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Azienda Ospedaliero-Universitaria Careggi, Ospedale Sacro Cuore Don Calabria, University of Padua, Azienda Ospedale - Università Padova, Humanitas University, IRCCS Humanitas Research Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Campania "Luigi Vanvitelli", University of Palermo, Universitat Autònoma de Barcelona, Vita-Salute San Raffaele University, A. O. Ordine Mauriziano di Torino
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Genetics
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $4,390
OpenAlex ID: W7222902012
FWCI:
Cites:
Cited by:
Related to: