Fate of the pouch in 151 pediatric patients after ileal pouch anal anastomosis

• Published in: Journal of pediatric surgery 2003-01, Vol.38 (1), p.78-82
• Main Authors: Alexander, Frederick, Sarigol, Samra, DiFiore, John, Stallion, Anthony, Cotman, Kathy, Clark, Holly, Lydzinski, Barb, Fazio, Victor
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anal Canal - surgery; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Anastomosis, Surgical - mortality; Biological and medical sciences; Child; Child, Preschool; Colitis, Ulcerative - surgery; Colonic Pouches - adverse effects; Crohn Disease - epidemiology; Crohn Disease - surgery; Crohn's disease; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; ileoanal pull-through procedure; indeterminant colitis; Male; Medical sciences; Other diseases. Semiology; pouchitis; Pouchitis - epidemiology; Retrospective Studies; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1053/jpsu.2003.50015

Background/Purpose: Ileal pouch anal anastomosis (IPAA) offers many pediatric patients a surgical cure for mucosal ulcerative colitis (MUC) with preservation of anal continence. However, some patients incur serious problems after surgery including chronic pouchitis and pouch failure. The goal of this study is to identify clinical and pathologic factors that are associated with an adverse outcome of IPAA. Methods: A retrospective analysis of outcome was performed in 151 consecutive patients ≤ 21 years of age who underwent IPAA with a mean follow-up of 7.24 years (range, 2 to 15 years). Patients were categorized into 4 outcome groups: A, no pouchitis; B, mild, acute pouchitis; C, chronic refractory pouchitis; and D, pouch failure. Pairwise comparisons were used to test the association between the groups and clinical and pathologic variables including age, sex, duration of symptoms, perianal disease, colonoscopic histology, terminal ileitis, operation type, staged versus unstaged IPAA, colonic specimen histology, early postoperative complications defined as less than 31 days postsurgery, late postoperative complications defined as 31 or more days postsurgery, and pouch fistulae. Crohn's disease as a definitive diagnosis and indeterminant colitis, a histologic diagnosis, also were tested for association with the above variables and outcome groups. Results: One hundred and fifty-one pediatric patients underwent IPAA utilizing mucosectomy and hand-sewn S or J (n = 44) and stapled J or S-W anastomosis (n = 107) with 0% mortality rate and outcome as follows: group A, n = 54; group B, n = 73; group C, n = 11; group D, n = 13. Variables strongly associated with poor outcome, groups C and D, were duration of symptoms (P =.03), perianal disease (P =.03), late complications (P