Advanced Biomedical Research
Early Outcome of Patient with Ulcerative Colitis who Received High Dose of Steroid and Underwent Two Staged Total Proctocolectomy
Document Type : Original Article
Authors
Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Ulcerative colitis (UC) is an idiopathic inflammatory disorder. Currently, the final treatment is colectomy. The aim of this study was to investigate the outcomes of proctocolectomy in patients that used a high dose of prednisolone. Materials and Methods: Seventy-five patients presenting for surgical management of histopathologically proven UC. All patients were offered total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA). Patients were divided into two groups: low dose of steroids (Group A) and high dose of steroid (Group B) consumers. Data from these patients after 2 years were reviewed and analyzed. Results: From total patients, 34 of them were male and 34 ones were female and seven patients underwent laparatomy. Overall incontinence rate was 8.8%; dysplasia was 22%, pouchitis was 18.9% while mortality was nil. The length of hospital stay was 6.76 days in Group A and 9.21 days in Group B (P = 0.399). Leakage was observed in nine of the patients after surgery (P = 0.589). Fecal incontinence between two groups was not statistically different (P = 0.063). Conclusions: Laparoscopic TPC-IPAA is feasible in patients needing surgical management of UC. Preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.
Keywords
| 1. |
Mosli MH, Feagan BG, Sandborn WJ, D'haens G, Behling C, Kaplan K, et al. Histologic evaluation of ulcerative colitis: A systematic review of disease activity indices. Inflamm Bowel Dis 2014;20:564-75.  |
| 2. |
Hosseini SV, Taghavi SA, Jafari P, Rezaianzadeh A, Moini M, Mehrabi M, et al. Safarpour, incidence of ulcerative colitis relapse: A prospective cohort study in Southern Iran. Ann Colorectal Res 2016;4:e34565. |
| 3. |
Scoglio D, Ali UA, Fichera A. Surgical treatment of ulcerative colitis: Ileorectal vs ileal pouch-anal anastomosis. World J Gastroenterol 2014;20:13211-8. |
| 4. |
Beaugerie L, Itzkowitz SH. Cancers complicating inflammatory bowel disease. N Engl J Med 2015;372:1441-52. [PUBMED] |
| 5. |
Jani K, Shah A. Laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. J Minim Access Surg 2015;11:177-83. [PUBMED] |
| 6. |
Leitner GC, Vogelsang H. Pharmacological- and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults. World J Gastrointest Pharmacol Ther 2016;7:5-20. [PUBMED] |
| 7. |
Meier J, Sturm A. Current treatment of ulcerative colitis. World J Gastroenterol 2011;17:3204-12. [PUBMED] |
| 8. |
Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2010;105:501-23. |
| 9. | |
| 10. |
Ma C, Crespin M, Proulx MC, DeSilva S, Hubbard J, Prusinkiewicz M, et al. Postoperative complications following colectomy for ulcerative colitis: A validation study. BMC Gastroenterol 2012;12:39. [PUBMED] |
| 11. |
Hermann J, Szmeja J, Kościński T, Meissner W, Drews M. Primary ileo-anal pouch anastomosis in patients with acute ulcerative colitis. Arch Med Sci 2013;9:283-7. |
| 12. |
Ryoo SB, Oh HK, Han EC, Ha HK, Moon SH, Choe EK, et al. Complications after ileal pouch-anal anastomosis in Korean patients with ulcerative colitis. World J Gastroenterol 2014;20:7488-96. [PUBMED] |
| 13. |
Balachandran R, Tøttrup A. Safety of proctocolectomy for ulcerative colitis under elective and non-elective circumstances: Preoperative corticosteroid treatment worsens outcome. Dig Surg 2015;32:251-7.
|
)