title: Should ileoanal pouch surgery be staged for patients with mucosal ulcerative colitis on immunosuppressives?
abstract: OBJECTIVE
  Much debate has revolved around whether patients with mucosal ulcerative colitis (MUC) receiving immunosuppression should be weaned off immunosuppressives before undergoing ileal pouch surgery. Therefore, the aim of this study was to assess the affect of immunosuppressive drugs on postoperative complications after ileoanal pouch surgery.
  
  
  METHODS
  A retrospective medical record review of patients with MUC who underwent ileal pouch surgery while taking immunosuppressive drugs such as azathioprine, 6-mercaptopurine (6-MP), methotrexate, and cyclosporin A was performed. Postoperative complications in the study group were compared to three matched groups: patients with MUC who had ileoanal pouch surgery while taking systemic steroids, patients with MUC not receiving any immunosuppressive drugs, and patients with familial adenomatous polyposis.
  
  
  RESULTS
  Twenty-two patients with MUC who underwent ileoanal pouch surgery while taking immunosuppressive drugs were identified from a prospectively entered database of patients who had this surgery between 1988 and 2005. All but two patients underwent temporary fecal diversion. Fifteen patients were taking 6-MP or azathioprine; six were on cyclosporine A, and one both on azathioprine and cyclosporine A. Fifteen patients were also taking steroids at the time of ileoanal pouch surgery. Early (within 30 days of surgery) and late complications occurred in 36 and 50% of the study group patients, respectively, but did not significantly differ from a matched group of patients with MUC who did not take immunosuppressive drugs. Patients with familial adenomatous polyposis had a significantly lower long-term complication rate.
  
  
  CONCLUSIONS
  This retrospective case-matched study suggests that the use of immunosuppressive drugs and cyclosporine A may not be associated with an increased rate of complications after ileoanal pouch surgery.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.
authors.forename: Oded
authors.initials: O
authors.lastname: Zmora
authors.forename: Marat
authors.initials: M
authors.lastname: Khaikin
authors.forename: Turab
authors.initials: T
authors.lastname: Pishori
authors.forename: Alon
authors.initials: A
authors.lastname: Pikarsky
authors.forename: Adam
authors.initials: A
authors.lastname: Dinnewitzer
authors.forename: Eric G
authors.initials: EG
authors.lastname: Weiss
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents