title: Outcomes after ileal pouch anal anastomosis in patients with primary sclerosing cholangitis.
abstract: OBJECTIVE
  Outcomes after ileal pouch anal anastomosis (IPAA) are not well established in patients with primary sclerosing cholangitis (PSC). We conducted a comprehensive outcomes assessment in these patients.
  
  
  METHODS
  A retrospective case note review of complications in all PSC-IPAA (n=21) and matched ulcerative colitis patients with IPAA (UC-IPAA; n=79) after surgery in Oxford (1983-2012) was conducted, and functional outcomes (Öresland score) were evaluated (2012). Quality of life [Cleveland Global Quality of Life Questionnaire, Short Form-36 (SF-36)], and sexual function were also assessed (2012) including patients with PSC-associated UC without IPAA (PSC-UC; n=19). Sub-group analysis of patients with large duct (ld) PSC-IPAA (n=17) was also performed.
  
  
  RESULTS
  The 1-, 5-, 10- and 20-year risk of acute pouchitis for PSC-IPAA was 10%, 19%, 31% and 65% respectively, compared to 3%, 10%, 14% and 28% in UC-IPAA (p=0.03). More PSC-IPAA (36%) had poor nocturnal pouch function (vs 2% in UC-IPAA; p=0.0016). There were no differences in surgical complications, quality of life or sexual function between the 3 main groups. LdPSC-IPAA had poorer pouch function (Öresland score: 7.7 vs 5.4 in UC-IPAA; p=0.02), and worse quality of life [SF-36 Physical: 42 vs 50.5 in UC-IPAA; 47.7 in PSC-UC; p=0.03 and Mental Health summary scores: 41.6 vs 51.2 in UC-IPAA; 42.3 in PSC-UC; p=0.04].
  
  
  CONCLUSIONS
  PSC-IPAA suffer more acute pouchitis and have worse functional outcomes than UC-IPAA. LdPSC-IPAA also have poorer quality of life.
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, Oxford, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Pavlides
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, Oxford, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Cleland
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, Oxford, UK.
authors.forename: Monira
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Division of Medical Sciences, University of Oxford, Oxford, UK.
authors.forename: Annabel
authors.initials: A
authors.lastname: Christian
authors.affiliation: Division of Medical Sciences, University of Oxford, Oxford, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Doyle
authors.affiliation: Department of Statistics, University of Oxford, Oxford, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Gaunt
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, Oxford, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Travis
authors.affiliation: Nuffield Department of Surgery, University of Oxford, Oxford, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Mortensen
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, Oxford, UK. Electronic address: roger.chapman@ndm.ox.ac.uk.
authors.forename: Roger
authors.initials: R
authors.lastname: Chapman
mesh_terms: D000038:Abscess / Q000209:etiology*; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D019449:Pouchitis / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D011788:Quality of Life; D019529:Sexuality
keywords: Acute pouchitis; Pouch dysfunction; Quality of life; Sexual function