Short- and Long-Term Surgical Outcomes in Patients Undergoing Proctocolectomy With Ileal Pouch-Anal Anastomosis in the Setting of Primary Sclerosing Cholangitis

Abstract

Primary sclerosing cholangitis occurs in approximately 10% of patients with ulcerative colitis, but studies involving IPAA in patients with cholangitis have been reported in limited numbers. This study aimed to examine surgical outcomes in patients with ulcerative colitis and sclerosing cholangitis undergoing total proctocolectomy with IPAA and to identify variables associated with surgical complications. This is a retrospective cohort study. This study was conducted at a single tertiary referral institution. Included were all patients with cholangitis and ulcerative colitis who underwent proctocolectomy with IPAA from 1994 to 2005. Perioperative morbidity, long-term pouch function, and pouch survival were the main outcome measures. One hundred patients (62 male) were studied. Forty-three percent were on steroids. There was no perioperative mortality, and 51 30-day complications occurred in 39 patients (39%). Median follow-up time was 5.9 years (range, 0.14-16.2 y). Pouch failure occurred in 3 patients (3%). The single variable that predicted 30-day morbidity was previous abdominal surgery (P = .03). Prednisone use, body mass index, age, ASA score, preoperative Model for End Stage Liver Disease score, and year of surgery were not significantly associated with short-term complications. IPAA can be performed safely in the setting of sclerosing cholangitis. The preoperative Model for End-stage Liver Disease Score and the use of preoperative immunosuppressive agents are not associated with an increased risk of complications. The likelihood of long-term pouch survival is excellent.