Clinical Outcomes After Ileal Pouch-Anal Anastomosis in Pediatric Patients

Christina C. Huang, Frederick Rescorla, Matthew P. Landman

Research output: Contribution to journalArticle

Abstract

Background: Ileal pouch-anal anastomosis (IPAA) is the standard surgical reconstruction for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) who undergo total proctocolectomy (TPC). Although patients receive the same reconstruction, their postoperative complications can differ. We hypothesize that indication for TPC and other preoperative clinical factors are associated with differences in postoperative outcomes following IPAA. Methods: A retrospective cohort of pediatric patients who underwent proctocolectomy with IPAA from 1996 to 2016 was identified. Preoperative, operative, and postoperative clinical variables were collected. Univariate analyses were performed to evaluate for relevant postoperative clinical differences. Results: Seventy-nine patients, 17 with FAP and 62 with UC, were identified. FAP patients spent a mean of 1125 ± 1011 d between initial diagnosis and first surgery compared to 585 ± 706 d by UC patients (P = 0.038). FAP patients took a mean of 57 ± 38 d to complete TPC with IPAA compared to UC patients at 177 ± 121 d (P < 0.001). FAP and UC patients did not differ in mean number of bowel movements at their 6-mo postoperative visit (4.7 ± 2.1 versus 5.6 ± 1.9, respectively [P = 0.134]). FAP patients were less likely to experience pouchitis (P = 0.009), pouch failure (P < 0.001), and psychiatric symptoms (P = 0.019) but more likely to experience bowel obstruction (P = 0.002). Conclusions: IPAA is a safe, restorative treatment for FAP and UC patients after TPC. Based on diagnosis and preoperative course, there are differences in morbidity in IPAA patients. Clinical data such as these will allow surgeons to help families anticipate their child's preoperative and postoperative courses and to maximize successful postoperative outcomes.

LanguageEnglish (US)
Pages72-76
Number of pages5
JournalJournal of Surgical Research
Volume234
DOIs
StatePublished - Feb 1 2019

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Colonic Pouches
Adenomatous Polyposis Coli
Pediatrics
Ulcerative Colitis
Pouchitis
Psychiatry

Keywords

  • Familial adenomatous polyposis
  • Ileal pouch-anal anastomosis
  • Total proctocolectomy
  • Ulcerative colitis

ASJC Scopus subject areas

  • Surgery

Cite this

Clinical Outcomes After Ileal Pouch-Anal Anastomosis in Pediatric Patients. / Huang, Christina C.; Rescorla, Frederick; Landman, Matthew P.

In: Journal of Surgical Research, Vol. 234, 01.02.2019, p. 72-76.

Research output: Contribution to journalArticle

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abstract = "Background: Ileal pouch-anal anastomosis (IPAA) is the standard surgical reconstruction for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) who undergo total proctocolectomy (TPC). Although patients receive the same reconstruction, their postoperative complications can differ. We hypothesize that indication for TPC and other preoperative clinical factors are associated with differences in postoperative outcomes following IPAA. Methods: A retrospective cohort of pediatric patients who underwent proctocolectomy with IPAA from 1996 to 2016 was identified. Preoperative, operative, and postoperative clinical variables were collected. Univariate analyses were performed to evaluate for relevant postoperative clinical differences. Results: Seventy-nine patients, 17 with FAP and 62 with UC, were identified. FAP patients spent a mean of 1125 ± 1011 d between initial diagnosis and first surgery compared to 585 ± 706 d by UC patients (P = 0.038). FAP patients took a mean of 57 ± 38 d to complete TPC with IPAA compared to UC patients at 177 ± 121 d (P < 0.001). FAP and UC patients did not differ in mean number of bowel movements at their 6-mo postoperative visit (4.7 ± 2.1 versus 5.6 ± 1.9, respectively [P = 0.134]). FAP patients were less likely to experience pouchitis (P = 0.009), pouch failure (P < 0.001), and psychiatric symptoms (P = 0.019) but more likely to experience bowel obstruction (P = 0.002). Conclusions: IPAA is a safe, restorative treatment for FAP and UC patients after TPC. Based on diagnosis and preoperative course, there are differences in morbidity in IPAA patients. Clinical data such as these will allow surgeons to help families anticipate their child's preoperative and postoperative courses and to maximize successful postoperative outcomes.",
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AB - Background: Ileal pouch-anal anastomosis (IPAA) is the standard surgical reconstruction for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) who undergo total proctocolectomy (TPC). Although patients receive the same reconstruction, their postoperative complications can differ. We hypothesize that indication for TPC and other preoperative clinical factors are associated with differences in postoperative outcomes following IPAA. Methods: A retrospective cohort of pediatric patients who underwent proctocolectomy with IPAA from 1996 to 2016 was identified. Preoperative, operative, and postoperative clinical variables were collected. Univariate analyses were performed to evaluate for relevant postoperative clinical differences. Results: Seventy-nine patients, 17 with FAP and 62 with UC, were identified. FAP patients spent a mean of 1125 ± 1011 d between initial diagnosis and first surgery compared to 585 ± 706 d by UC patients (P = 0.038). FAP patients took a mean of 57 ± 38 d to complete TPC with IPAA compared to UC patients at 177 ± 121 d (P < 0.001). FAP and UC patients did not differ in mean number of bowel movements at their 6-mo postoperative visit (4.7 ± 2.1 versus 5.6 ± 1.9, respectively [P = 0.134]). FAP patients were less likely to experience pouchitis (P = 0.009), pouch failure (P < 0.001), and psychiatric symptoms (P = 0.019) but more likely to experience bowel obstruction (P = 0.002). Conclusions: IPAA is a safe, restorative treatment for FAP and UC patients after TPC. Based on diagnosis and preoperative course, there are differences in morbidity in IPAA patients. Clinical data such as these will allow surgeons to help families anticipate their child's preoperative and postoperative courses and to maximize successful postoperative outcomes.

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