Long-term outcomes and sex differences after restorative proctocolectomy in pediatric patients with ulcerative colitis

Abstract Background Restorative proctocolectomy (RPC) for ulcerative colitis (UC) could result in a higher patient quality of life, avoiding frequent disease flares; however, pouch failures and pouch-related complications (PRCs) can develop. Purpose No cohort studies have examined pouch failure and...

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Bibliographic Details
Published in:Journal of pediatric surgery 2016-03, Vol.51 (3), p.454-460
Main Authors: Hirata, Akihiro, Uchino, Motoi, Bando, Toshihiro, Hirose, Kei, Chohno, Teruhiro, Sasaki, Hirofumi, Horio, Yuki, Nakamura, Shiro, Hida, Nobuyui, Hori, Kazutoshi, Tomita, Naohiro, Takahashi, Yoshiko, Takesue, Yoshio, Ikeuchi, Hiroki
Format: Article
Language:English
Subjects:
Adolescent
Adult
Child
Colitis, Ulcerative - surgery
Female
Follow-Up Studies
Humans
Male
Pediatric
Pediatrics
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Pouch failure
Pouch-related complication
Proctocolectomy, Restorative
Restorative proctocolectomy
Retrospective Studies
Risk Factors
Sex Factors
Surgery
Treatment Failure
Ulcerative colitis
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Summary:Abstract Background Restorative proctocolectomy (RPC) for ulcerative colitis (UC) could result in a higher patient quality of life, avoiding frequent disease flares; however, pouch failures and pouch-related complications (PRCs) can develop. Purpose No cohort studies have examined pouch failure and the differences between adult and pediatric patients or the sex differences in pediatric UC. Therefore, the pouch failure rates were compared between adults and pediatric patients, and pouch failure and PRCs in pediatric UC were evaluated. Methods UC patients who underwent RPC between January 1987 and June 2014 at Hyogo College of Medicine were included. Patient background characteristics, PRCs, and pouch failure were reviewed. Results A total of 1347 adult UC patients and 90 (51 boys, 39 girls) pediatric UC patients were included in the study. The cumulative rate of pouch failure at 10 years after RPC was significantly higher in pediatric UC (9.5%) than in adult UC (2.1%; p < 0.01). In pediatric UC, the independent risk factors for pouch failure were pouchitis (hazard ratio (HR) 19.3) and anal fistula (HR 5.5). Although a sex difference was not seen in pouch failure, an independent risk factor for PRCs was being a girl (HR 2.5). Conclusions Pouch failure was more common in pediatric than in adult UC. PRCs after RPC were more common in girls in pediatric UC.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2015.10.042