Central Surgical AssociationSurgical outcome in patients with primary sclerosing cholangitis undergoing ileal pouch–anal anastomosis: A case-control study
Section snippets
Materials and methods
By using our institutional review board–approved pelvic pouch database, we identified the patients with PSC and IBD who underwent RP/IPAA between 1983 and 2002. This study group was matched for age, gender, diagnosis, time to diagnosis, anastomosis technique, and proximal diversion to a cohort of IBD patients with no associated PSC who underwent RP during the same period of time. The pelvic pouch database provided the information on patients' demographics, disease history, dysplasia/cancer,
Results
From 1983 to December 2002, 2557 RPs and IPAAs were performed at the Cleveland Clinic Foundation Colorectal Surgery Department. During this period, there were 65 IBD patients with associated PSC who underwent RP/IPAA, and this was designated as the study cohort. Patients in the study group were compared with a cohort of patients with IBD with no associated PSC disease (N = 260) who underwent RP/IPAA during the same period of time. The results of the matching criteria are listed in Table I.
Discussion
The outcome of RP/IPAA in UC patients with associated PSC has not been well-established. Orthotopic liver transplantation (OLTx) is currently the curative treatment for PSC, but the surgical management of patients who have both UC and PSC can be difficult. The results of our current study suggest that the risk of postoperative pelvic sepsis, cancer/neoplasia in the resected specimen, and long-term mortality after RP/IPAA is higher in IBD patients with associated PSC in comparison with IBD
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Primary Sclerosing Cholangitis–Associated Pouchitis: A Distinct Clinical Phenotype
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2019, Surgical Clinics of North AmericaCitation Excerpt :In contrast, patients with primary sclerosing cholangitis (PSC) and UC who undergo IPAA have rates of pouchitis (63%–75%41) compared with UC patients without PSC.39,41 It has been suggested that pouchitis may be more common in PSC patients due to their higher risk of postoperative complications, such as pelvic sepsis, which increases risk of chronic inflammation.42 The selective development of pouchitis based on indication for IPAA suggests that stasis of intestinal contents in the small intestine does not fully explain the inflammatory changes that occur.
The cleveland classification of ileal pouch disorders
2018, Pouchitis and Ileal Pouch Disorders: A Multidisciplinary Approach for Diagnosis and ManagementExtraintestinal manifestations and concurrent autoimmune disorders in pouch patients
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2018, Pouchitis and Ileal Pouch Disorders: A Multidisciplinary Approach for Diagnosis and Management
Presented at the 62nd Annual Meeting of the Central Surgical Association, Tucson, Arizona, March 10-12, 2005.