Risk factors associated with portomesenteric venous thrombosis in patients undergoing restorative proctocolectomy for medically refractory ulcerative colitis

• Published in: Colorectal disease Vol. 18; no. 4; pp. 393 - 399
• Main Authors: Gu, J., Stocchi, L., Gorgun, E., Remzi, F. H.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.04.2016
• Subjects: Adult; Age Factors; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - surgery; Colonic Pouches; Female; Humans; ileal pouch-anal anastomosis; Ileostomy - adverse effects; Incidence; Length of Stay; Male; Mesenteric Ischemia - epidemiology; Mesenteric Ischemia - etiology; Mesenteric Veins; Middle Aged; Multivariate Analysis; Portal Vein; Portomesenteric venous thrombosis; Postoperative Complications; Preoperative Period; Proctocolectomy, Restorative - adverse effects; Proctocolectomy, Restorative - methods; Prospective Studies; restorative proctocolectomy; Retrospective Studies; Risk Factors; Serum Albumin - analysis; Steroids - adverse effects; ulcerative colitis; restorative proctocolectomy; Portomesenteric venous thrombosis; ulcerative colitis; ileal pouch-anal anastomosis
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13275

Aim Data on risk factors for portomesenteric venous thrombosis (PMVT) following abdominal surgery for ulcerative colitis (UC) are limited. The aim of this study was to investigate factors associated with PMVT after surgical treatment for UC. Method Patients who underwent restorative proctocolectomy (RPC) and ileal pouch‐anal anastomosis (IPAA) including diverting ileostomy closure for medically refractory UC were identified from a prospectively maintained database. Patient‐related, disease‐related and treatment‐related variables were collected. Univariable and multivariable analyses were performed to assess factors associated with PMVT. Results Of the 521 patients completing surgical treatment for UC between 2006 and 2012, symptomatic PMVT occurred in 36 (7%), which resulted in a significantly increased hospital stay (P < 0.001). Patients developing PMVT were younger (P = 0.014), had a lower preoperative albumin level (P = 0.037) and were more likely to have been taking steroids within 1 month before surgery (P = 0.006). The combined incidence of PMVT was comparable between patients having a three‐stage and two‐stage management (6% vs 8%, P = 0.43), but the relative incidence of PMVT after RPC + IPAA was 8%, significantly higher than the 4% after total abdominal colectomy (TAC) (P = 0.005) and the 2% after subsequent completion proctectomy (CP) + IPAA (P = 0.038). Multivariate analysis confirmed that RPC + IPAA was associated with a significantly greater risk of PMVT than CP + IPAA (OR = 4.9, P = 0.003) or TAC (OR = 3.5, P = 0.011). Preoperative steroid use was an independent factor for PMVT (OR = 5.8, P = 0.006). Conclusion Steroid use 1 month before surgery is associated with an increased risk of PMVT. A staged restorative proctocolectomy does not increase the overall incidence of PMVT.