Re: pre-cirrhosis surgery for management of PSC

[Guest guest]

>

> Meanwhile, Ian, did you read the article Barb just posted about pre-

> cirrhosis surgery for management of PSC? [Primary sclerosing

cholangitis: role of extrahepatic biliary resection (EHBR). J Am Coll

Surg. 2008 May;206(5):822-30] I had a little trouble

> getting through it but i THINK it said that Hopkins is advising non-

> cirrhotic PSC patients with increased levels of Bilirubin to undergo

> surgery on their biliary tract? Is that right? ...

The phrase used was " can be successfully managed with EHBR " . I read

this as saying EHBR should be considered as one option in the

management of PSC for non-cirrhotic patients with high bilirubin.

Like Ian, in 1989 I underwent an EHBR, replacing my extrahepatic bile

ducts with a section of bowel. Unlike him, my PSC continued to

progress and I received a liver transplant in 1998 - during which 104

pints of blood were used. The recent paper (msg 103664) " Primary

sclerosing cholangitis " by M Silverira & K Lindor, Can J Gastroenterol

2008;22(8):689-698, says, " Presently, biliary surgery in patients with

PSC, other than simple cholecystectomy, should be minimized and

reserved for selected rare noncirrhotic patients who have marked

cholestasis or recurrent cholangitis caused by a dominant extrahepatic

or hilar stricture not amenable to endoscopic or percutaneous dilation

(71). In patients who may undergo liver transplantation, previous

biliary surgery has been associated with a significantly longer

operation time, greater interoperative blood loss and a higher

incidence of biliary complications following liver transplantation

compared with those patients with no history of biliary surgery (76-89). "

Twenty years ago, many of the complications of EHBR were not yet known

and endoscopic operators not nearly so adept as they are now, so an

EHBR was my best option at the time. Now I would advise very careful

consideration before choosing that route.

Tim R, ltx 4/4/98, 6/18/07 & 7/7/07