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Laparoscopic colectomy for ulcerative colitis with associated auto-immune liver disease and portal hypertension

Research output: Chapter in Book/Report/Conference proceedingChapter

B Vadamalayan, B B Lakshminarayanan, E Fitzpatrick, M Samyn, A Desai, J Nun-Mensah, N Ade Ajayi

Original languageEnglish
Title of host publicationJournal of Pediatric Gastroenterology and Nutrition
PublisherLippincott Williams and Wilkins
Pages329
Number of pages1
ISBN (Print)1536-4801
DOIs
Publication statusPublished - 2016

Publication series

NameJournal of Pediatric Gastroenterology and Nutrition
Volume62

King's Authors

Abstract

Objectives and study: Laparoscopic colectomy for ulcerative colitis (UC) is well established. However, patients with UC and auto-immune liver disease (AILD) pose unique management and technical challenges. This is particularly true of those with established variceal disease. We report our laparoscopic experience in this rare group of patients. Bhanu Lakshminarayanan1, Marianne Samyn2, Babu Vadamalayan2, Ashish Desai1, Joseph Nunoo- Mensah3, Niyi Ade-Ajayi1 Methods: Patients with UC and AILD who underwent surgery were retrospectively reviewed since 2009. Data regarding age at surgery, pre-operative work up, operative procedure and operative times were noted. Results: 10 patients with UC and AILD were identified in the study period. 5 patients (4 male, median age of 16 years) underwent total colectomy (3 laparoscopic, 2 open of which 1 was done as a combined procedure with liver transplant [LT]). Of the other 5 patients, 4 underwent LT. 1 patient with severe varices in whom laparoscopic colectomy (LC) was considered too hazardous is awaiting colectomy which will be carried out at the same time as LT. Of the 3 patients who underwent LC, Propanalol was used to lower portal pressures in 1 pre-operatively. Haemostasis was achieved in all using LigaSure TM for vessel sealing. The mean operative time was 300 minutes (240 - 400 minutes). There were no immediate complications. One patient required revision ileostomy for obstructive symptoms one week after LC and subsequently underwent a laparoscopic J pouch anal anastomosis. One other patient had ileorectal anastomosis 1 year after LC. Conclusion: 1. UC and AILD progressing at different rates in the same patient may pose unique management challenges 2. Safe colectomy may not be feasible without LT in those with the most severe variceal disease 3. With suitable pre-operative preparation, laparoscopic colectomy is feasible and safe in selected patients with UC and AILD.

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