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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2023; 15(2): 234-248
Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.234
Hepatobiliary manifestations following two-stages elective laparoscopic restorative proctocolectomy for patients with ulcerative colitis: A prospective observational study
Tamer A A M Habeeb, Abdulzahra Hussain, Mauro Podda, Pasquale Cianci, Bruce Ramshaw, Khaled Safwat, Wesam M Amr, Tamer Wasefy, Alaa A Fiad, Mohamed Ibrahim Mansour, Adel Mahmoud Moursi, Gamal Osman, Anass Qasem, Mohamed Fawzy, Mohamed Ibrahim Abo Alsaad, Abd-Elfattah Kalmoush, Mohammed Shaaban Nassar, Fawzy M Mustafa, Mahmoud Hassib Morsi Badawy, Ahmed Hamdy, Hamdi Elbelkasi, Bassam Mousa, Abd-Elrahman M Metwalli, Walid A Mawla, Mostafa M Elaidy, Muhammad Ali Baghdadi, Ahmed Raafat
Tamer A A M Habeeb, Khaled Safwat, Wesam M Amr, Tamer Wasefy, Alaa A Fiad, Mohamed Ibrahim Mansour, Adel Mahmoud Moursi, Gamal Osman, Bassam Mousa, Abd-Elrahman M Metwalli, Walid A Mawla, Mostafa M Elaidy, Muhammad Ali Baghdadi, Ahmed Raafat, Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig 44759, Sharkia, Egypt
Abdulzahra Hussain, Homerton University Hospital, London E9 6SR, UK
Mauro Podda, Department of Surgical Science, University of Cagliari, Cagliari 2432, Italy
Pasquale Cianci, Department of Medical and Surgical Sciences, Università degli studi di Foggia, Foggia 546, Italy
Bruce Ramshaw, MD CQInsights PBC, Co-founder & CEO, Tennessee, TN 37010, United States
Anass Qasem, Department of Internal Medicine, Zagazig University, Zagazig 2355, Egypt
Mohamed Fawzy, Department of Internal Medicine, Suez University, Suez 235, Egypt
Mohamed Ibrahim Abo Alsaad, Department of General Surgery, Faculty of Medicine -Merit University, Sohag 82511, Egypt
Abd-Elfattah Kalmoush, Mohammed Shaaban Nassar, Fawzy M Mustafa, Mahmoud Hassib Morsi Badawy, Department of General Surgery, Al-azhar University, Cairo 285, Egypt
Ahmed Hamdy, Department of Hepato-Bilio-Pancreatic (HBP) Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo 285, Egypt
Hamdi Elbelkasi, Department of General Surgery, Mataryia Teaching Hospital, Cairo 285, Egypt
Author contributions: Habeeb TAAM is the corresponding author and is responsible for patient recruitment; Habeeb TAAM, Hussain A, Podda M, Cianci P, Ramshaw B, Safwat K, Amr WM, Wasefy T, Fiad AA, Mansour MI, Moursi AM, Osman G, Qasem A, Fawzy M, Alsaad MIA, Kalmoush A, Nassar MS, Mustafa FM, Badawy MHM, Hamdy A, Elbelkasi H, Mousa B, Metwalli AM, Mawla WA, Elaidy MM, Baghdadi MA, Raafat A shared data collection, data analysis, study design, and writing up the first draft and final form of the manuscript; All authors accept the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Zagazig University Institutional Review Board (Approval No. ZU IRB#9841).
Informed consent statement: Informed written consent was obtained from the patient and her family for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data will be available by the author on demand.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Tamer A A M Habeeb, MD, Professor, Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig 44759, Sharkia, Egypt.
tameralnaimy@hotmail.com
Received: October 7, 2022
Peer-review started: October 7, 2022
First decision: January 3, 2023
Revised: January 5, 2023
Accepted: February 3, 2023
Article in press: February 3, 2023
Published online: February 27, 2023
Processing time: 143 Days and 11.3 Hours
BACKGROUND
Hepatobiliary manifestations occur in ulcerative colitis (UC) patients. The effect of laparoscopic restorative proctocolectomy (LRP) with ileal pouch anal anastomosis (IPAA) on hepatobiliary manifestations is debated.
AIM
To evaluate hepatobiliary changes after two-stages elective laparoscopic restorative proctocolectomy for patients with UC.
METHODS
Between June 2013 and June 2018, 167 patients with hepatobiliary symptoms underwent two-stage elective LRP for UC in a prospective observational study. Patients with UC and having at least one hepatobiliary manifestation who underwent LRP with IPAA were included in the study. The patients were followed up for four years to assess the outcomes of hepatobiliary manifestations.
RESULTS
The patients' mean age was 36 ± 8 years, and males predominated (67.1%). The most common hepatobiliary diagnostic method was liver biopsy (85.6%), followed by Magnetic resonance cholangiopancreatography (63.5%), Antineutrophil cytoplasmic antibodies (62.5%), abdominal ultrasonography (35.9%), and Endoscopic retrograde cholangiopancreatography (6%). The most common hepatobiliary symptom was Primary sclerosing cholangitis (PSC) (62.3%), followed by fatty liver (16.8%) and gallbladder stone (10.2%). 66.4% of patients showed a stable course after surgery. Progressive or regressive courses occurred in 16.8% of each. Mortality was 6%, and recurrence or progression of symptoms required surgery for 15%. Most PSC patients (87.5%) had a stable course, and only 12.5% became worse. Two-thirds (64.3%) of fatty liver patients showed a regressive course, while one-third (35.7%) showed a stable course. Survival rates were 98.8%, 97%, 95.8%, and 94% at 12 mo, 24 mo, 36 mo, and at the end of the follow-up.
CONCLUSION
In patients with UC who had LRP, there is a positive impact on hepatobiliary disease. It caused an improvement in PSC and fatty liver disease. The most prevalent unchanged course was PSC, while the most common improvement was fatty liver disease.
Core Tip: There has been little research on the efficacy of proctocolectomy in ulcerative colitis patients with hepatobiliary manifestations. The course of hepatobiliary symptoms after proctocolectomy is being evaluated prospectively in our study. The main finding of this study was that two-thirds of patients had an unchanged course following surgery, whereas 16.8% had a progressive or regressive course. The mortality rate was 6%, and 15% of patients required surgery due to recurrence or worsening symptoms. Most primary sclerosing cholangitis patients (87.5%) had an unchanged course, with only 12.5% progressing. Two-thirds (64.3%) of fatty liver patients progressed, whereas one-third (35.7%) remained stationary. At 12, 24, 36, and 48 mo, the survival rates were 98.8%, 97%, 95.8%, and 94%, respectively.
