title: Short- and long-term surgical outcomes in patients undergoing proctocolectomy with ileal pouch-anal anastomosis in the setting of primary sclerosing cholangitis.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  This is a retrospective cohort study.
  
  
  METHODS
  This study was conducted at a single tertiary referral institution.
  
  
  METHODS
  Included were all patients with cholangitis and ulcerative colitis who underwent proctocolectomy with IPAA from 1994 to 2005.
  
  
  METHODS
  Perioperative morbidity, long-term pouch function, and pouch survival were the main outcome measures.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mayo Clinic, Department of Surgery, Division of Colon and Rectal Surgery, Rochester, Minnesota, USA.
authors.forename: Kellie L
authors.initials: KL
authors.lastname: Mathis
authors.forename: Luis A
authors.initials: LA
authors.lastname: Benavente-Chenhalls
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Wolff
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D015209:Cholangitis, Sclerosing / Q000150:complications*; D003093:Colitis, Ulcerative / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D039021:Colonic Pouches; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult