Surgical aspects of sclerosing cholangitis. Results in 178 patients.

Abstract:

:Of 178 patients with sclerosing cholangitis treated since 1950, 88 patients had associated inflammatory bowel disease, 72 had no such history, and 18 had iatrogenic injury or stone disease. A total of 233 biliary operations were performed, with a 75% rate of temporary improvement after initial operation. Subsequent operations resulted in a lower success rate and a higher mortality rate. Radiologic findings included predominant extrahepatic, intrahepatic, and diffuse disease in 29%, 28%, and 43% of patients, respectively; no survival differences were noted. Seventy-five of one hundred three deaths (73%) were related to liver failure, bleeding, or sepsis. Of 14 patients undergoing portosystemic shunt, 13 died of surgical complications or related disease. Orthotopic liver transplantation was performed in 16 patients and resulted in eight deaths, mainly in patients who had previously undergone extensive surgical treatment. No survival differences were seen between the patients with inflammatory bowel disease, those without the condition, or those who had colectomy. Surgical treatment in patients with sclerosing cholangitis should be minimized. Orthotopic liver transplantation should be offered as the treatment of choice for patients with portal hypertension, refractory cholangitis, advanced cirrhosis, or progressive liver failure.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Martin FM,Rossi RL,Nugent FW,Scholz FJ,Jenkins RL,Lewis WD,Gagner M,Foley E,Braasch JW

doi

10.1097/00000658-199010000-00017

subject

Has Abstract

pub_date

1990-10-01 00:00:00

pages

551-6; discussion 556-8

issue

4

eissn

0003-4932

issn

1528-1140

journal_volume

212

pub_type

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