Analysis of a Modified Two-Stage Approach to Ileal Pouch-Anal Anastomosis Without Fecal Diversion in Pediatric Patients

• Published in: The American surgeon 2022-01, Vol.88 (1), p.103-108
• Main Authors: Marulanda, Kathleen, Purcell, Laura N., Egberg, Matthew D., Mangat, Sabrina A., McCauley, Christopher J., Chaumont, Nicole, Sadiq, Timothy S., Hayes-Jordan, Andrea A., Phillips, Michael R.
• Format: Article
• Language: English
• Subjects: Abdomen; Adolescent; Anastomosis; Anastomotic leak; Antibiotics; Body mass index; Child; Children; Colitis, Ulcerative - surgery; Complications; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Ileostomy; Ileostomy - statistics & numerical data; Inflammatory bowel disease; Intestinal obstruction; Length of Stay; Male; Medical personnel; Narcotics; Operative Time; Opioids; Ostomy; Patient Readmission - statistics & numerical data; Patients; Pediatrics; Postoperative Complications - epidemiology; Postoperative period; Proctocolectomy, Restorative - adverse effects; Proctocolectomy, Restorative - methods; Proctocolectomy, Restorative - statistics & numerical data; Reoperation - statistics & numerical data; Retrospective Studies; Risk analysis; Risk factors; Steroids; Surgeons; Surgery; Surgical anastomosis; Surgical outcomes; Ulcerative colitis; Urinary retention; Urinary tract diseases; Urinary tract infections; Urogenital system; Variance analysis
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/0003134820981691

Background Fecal diversion after ileal pouch anal anastomosis (IPAA) in children with ulcerative colitis (UC) remains controversial. We hypothesize that a modified two-stage IPAA omitting diverting ileostomy (DI) after IPAA, found to be safe in adults, would produce similar results in children. Methods Retrospective, single-institution study of children (≤18 years) undergoing staged total proctocolectomy with IPAA from 2014 to 2020. Traditional two-stage and three-stage approaches including DI after IPAA were compared to two-stage approach without DI. Results 32 patients were included; of these, 7 (22%), 14 (44%), and 11 (34%) patients underwent traditional two-stage, modified two-stage, or three-stage IPAA, respectively. Following IPAA, modified two-stage patients had shorter operative time, decreased opioid utilization, quicker return to regular diet, and shorter stoma duration. After IPAA, there was similar postoperative length of stay, complication rates, readmissions, visits to the emergency department, or unplanned return to the operating room (OR) within 30 days. Anastomotic leak occurred in 2 patients; both were managed nonoperatively without evidence of pouch dysfunction. Conclusion Modified two-stage IPAA with omission of DI after the IPAA stage is safe to perform in pediatric UC patients. Prospective studies with larger sample sizes are needed to identify risk factors associated with operative complications.