Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.234
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
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.
To evaluate hepatobiliary changes after two-stages elective laparoscopic restorative proctocolectomy for patients with UC.
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.
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.
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.