Urgent subtotal colectomy for ulcerative colitis: a Modified Delphi e-consensus on behalf of the Italian Society of Colorectal Surgery (SICCR)

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.

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Publication Details

Journal
Techniques in Coloproctology
Published
2026-10-18
DOI
https://doi.org/10.1007/s10151-026-03435-0
Primary Topic
Inflammatory Bowel Disease
Type
article
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article

Urgent subtotal colectomy for ulcerative colitis: a Modified Delphi e-consensus on behalf of the Italian Society of Colorectal Surgery (SICCR)

Giuliano Barugola, Giovanni Tomasicchio, Michele Cricrì, I. Angriman et al.
Techniques in Coloproctology
Inflammatory Bowel Disease
article

Urgent subtotal colectomy for ulcerative colitis: a Modified Delphi e-consensus on behalf of the Italian Society of Colorectal Surgery (SICCR)

Giuliano Barugola, Giovanni Tomasicchio, Michele Cricrì, I. Angriman, Matteo Rottoli, Vittoria Bellato, Valerio Celentano, Francesco Selvaggi, Filippo Carannante, Gaetano Luglio, Arcangelo Picciariello, D. Passannanti, Michela Mineccia, R. Pietroletti, F. Colombo, P. De Nardi, G. T. Capolupo, S. Scaringi, M. Carvello, G. Calini, F. Sacchetti, L. Sofo, G. Pellino, A. Spinelli, G. Sampietro, F. Ferrara, C. Nesci
article en

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.

Techniques in Coloproctology
Università Cattolica del Sacro Cuore (IT), University of Rome Tor Vergata (IT), Universitat Autònoma de Barcelona (ES), Humanitas University (IT), University of Padua (IT), University of Salento (IT), Vita-Salute San Raffaele University (IT), Università Campus Bio-Medico (IT), University of Campania "Luigi Vanvitelli" (IT), Chelsea and Westminster Hospital NHS Foundation Trust (GB), Agostino Gemelli University Polyclinic (IT), Luigi Sacco Hospital (IT), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Azienda Ospedaliera Bolognini Seriate (IT), Ospedale Sacro Cuore Don Calabria (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Federico II University Hospital (IT), A. O. Ordine Mauriziano di Torino (IT), Policlinico Tor Vergata (IT), Campus Bio Medico University Hospital (IT), Azienda Ospedale - Università Padova (IT), ASST Fatebenefratelli Sacco (IT), IRCCS Humanitas Research Hospital (IT), Imperial College London (GB), University of Naples Federico II (IT), University of Palermo (IT), University of Bologna (IT)
Openalex Percentile: Top 14%
Inflammatory Bowel Disease
DOIOpen Access PDFOpenAlex
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