Surgical Reconstruction in Ulcerative Colitis With Primary Sclerosing Cholangitis
Surgical Reconstruction in Ulcerative Colitis With Primary Sclerosing Cholangitis
Primary sclerosing cholangitis (PSC) occurs in approximately 10 % of patients with ulcerative
 colitis (UC), but the outcome of reconstructive surgery is not clear. The purpose of this
 study was to determine the functional outcome after surgery, frequency of pouchitis,
 complications and failure-rate in UC-PSC patients compared to patients with UC alone. Both
 ileal pouch-anal anastomosis (IPAA) and ileo-rectal anastomosis (IRA) were studied.
Primary sclerosing cholangitis (PSC) is characterised by inflammation and fibrosis of the
 biliary tree and the condition can lead to end-stage liver disease. PSC is strongly
 associated with inflammatory bowel disease (IBD), with a prevalence of IBD in PSC as high as
 60-84 % in Northern Europe and North America. The majority of patients with IBD and PSC have
 ulcerative colitis (UC).

 Considering all patients with UC, around 30% will ultimately require surgery; the most common
 indications are acute colitis, chronic refractory disease or colorectal dysplasia. The
 standard procedure is proctocolectomy and ileal pouch-anal anastomosis (IPAA). However,
 ileo-rectal anastomosis (IRA) or conventional ileostomy are options. The prognosis after
 surgery is generally considered good.

 Previous studies have shown that the course of colitis in patients with UC/PSC is different
 from that of patients with UC-only.

 In a patient with UC, several aspects have to be considered at counselling before surgery.
 However, in many aspects, the literature is substantial for patients with UC-only (for
 example function and quality of life after IPAA) and key information can be safely provided.
 Conversely, patients with UC/PSC that require colectomy are rare and as a consequence, data
 on most aspects is sparse (18-20).

 The aim of the study was to assess outcome after surgery (IPAA or IRA) in patients with
 UC/PSC. Focus was on pouch/rectal function, pouchitis, surgical complications and failure.
 Patients with UC-only were employed as controls.
Inclusion Criteria:

 -  UC

 -  PSC

 -  IPAA

 -  IRA

 Exclusion Criteria:

 -  non-UC

 -  non-PSC

 -  no consent