COMPARISON OF SURGICAL-TREATMENT OF ULCERATIVE-COLITIS ASSOCIATED WITH PRIMARY SCLEROSING CHOLANGITIS - ILEAL POUCH-ANAL ANASTOMOSIS VERSUSBROOKE ILEOSTOMY

Objective: To compare the operative risks, operative complications, an d late outcome of two homogeneous groups of patients with chronic ulce rative colitis (CUC) and primary sclerosing cholangitis (PSC) who unde rwent either Brooke ileostomy or ileal pouch-anal anastomosis (IPAA). Material and Methods: Between 1970 and 1990, 72 patients with CUC and PSC underwent proctocolectomy with either Brooke ileostomy (group I; N = 32) or IPAA (group II; N = 40), Postoperative data included operati ve mortality, need for blood transfusion, general postoperative compli cations, liver-related complications, and proctocolectomy-related comp lications. Results: Light group I patients and nine group II patients had a total of 12 and 11 general complications, respectively, Liver-re lated complications were diagnosed in 16% and 10% of group I and group II patients, respectively. Proctocolectomy-specific complications occ urred in 34% of group T and 20% of group IT patients, The overall need for blood transfusion was 94% in group I and 47% in group II (P < 0.0 01). The cumulative probability of proctocolectomy-related complicatio ns at 5 years was 23% for group I and 64% for group II patients (P < 0 .002). The difference, however, was primarily due to the high frequenc y of pouchitis after IPAA, estimated at 57% at 4 years, The cumulative 5-year risk of liver-related complications was 37% and 28% for group I and group II, respectively, Peristomal varices and bleeding occurred in eight group I patients but in none of group II. Conclusion: Becaus e IPAA avoids bleeding problems, it is the surgical treatment of choic e in patients with PSC and CUC.