title: Inflammatory bowel disease complicated by primary sclerosing cholangitis and cirrhosis:  is restorative proctocolectomy safe?
abstract: BACKGROUND
  The pattern and severity of postoperative complications after colectomy and total proctocolectomy with ileoanal pouch for patients with IBD with liver cirrhosis from primary sclerosing cholangitis have not been well characterized.
  
  
  OBJECTIVE
  This study aimed to evaluate the immediate and long-term outcomes for patients with cirrhosis from primary sclerosing cholangitis undergoing colectomy for IBD.
  
  
  METHODS
  This is a retrospective study.
  
  
  METHODS
  This study was conducted at Cleveland Clinic, a tertiary medical center.
  
  
  METHODS
  From 1989 to 2009, 23 patients (22 ulcerative colitis and 1 Crohn's disease) who underwent colectomy were included.
  
  
  RESULTS
  The mean duration of primary sclerosing cholangitis before surgery was 6.8 ± 4.9 years, and the mean duration of IBD was 18 ± 10.7 years. All patients had cirrhosis; the mean Model for Endstage Liver Disease score was 9.3 ± 1.6, and most patients were Child Pugh class A or early B. Eight patients were on the orthotopic liver transplantation list. Indications for colectomy were dysplasia (n = 13), failure or complications of medical therapy (n = 7), cancer (n = 2), and colonic perforation at colonoscopy (n = 1). Nineteen patients (82.6%) developed postoperative complications including bleeding (43.5%), ileus (17.4%), wound infection (8.7%), worsening liver function (34.8%), pelvic abscess (13%), and deep vein thrombosis (8.7%). Two patients, both after total proctocolectomy/IPAA, died of septic shock after pelvic abscess in the postoperative period. Two patients underwent transjugular intrahepatic portosystemic shunt procedure before total proctocolectomy/IPAA; none developed pelvic abscess or mortality. There were no differences in mortality or morbidity between patients who underwent an ileoanal pouch procedure or colectomy with ileostomy.
  
  
  CONCLUSIONS
  Colectomy in patients with IBD complicated with cirrhotic primary sclerosing cholangitis is associated with a high early postoperative morbidity rate. Due consideration needs to be given to strategies to reduce pelvic sepsis, especially after ileoanal pouch, because this is associated with mortality.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Lian
authors.forename: K V Narayanan
authors.initials: KV
authors.lastname: Menon
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Feza
authors.initials: F
authors.lastname: Remzi
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000150:complications*; D003082:Colectomy; D005260:Female; D006801:Humans; D007081:Ileostomy; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D016896:Treatment Outcome