Yavuz Ozdemir1, Ravi P Kiran1, Hasan H Erem1, Erman Aytac1, Emre Gorgun1, David Magnuson2, Feza H Remzi3. 1. Department of Colorectal Surgery, Digestive Disease Institute, Children's Hospital, Cleveland Clinic, Cleveland, OH. 2. Department of Pediatric Surgery, Children's Hospital, Cleveland Clinic, Cleveland, OH. 3. Department of Colorectal Surgery, Digestive Disease Institute, Children's Hospital, Cleveland Clinic, Cleveland, OH. Electronic address: remzif@ccf.org.
Abstract
BACKGROUND: Data regarding the long-term outcomes of restorative proctocolectomy and ileal pouch anal anastomosis including pouch function and quality of life in the pediatric population are limited in pediatric patients. STUDY DESIGN: Indications for surgery, complications, long-term function, and quality of life were evaluated in pediatric patients undergoing ileal pouch anal anastomosis. Assessment of quality of life was performed using the Cleveland Global Quality of Life score. RESULTS: There were 433 patients with a mean age of 18.04 ± 2.9 years. Final pathologic diagnoses were ulcerative colitis or indeterminate colitis (78.3%), familial adenomatous polyposis (15.7%), Crohn's disease (5.1%), and others (0.9%). There were 237 patients (54.7%) who underwent total proctocolectomy and ileal pouch anal anastomosis; 196 (45.3%) underwent initial subtotal colectomy followed by completion proctectomy with ileal pouch anal anastomosis. Anastomosis was stapled in 352 patients (81.3%) and hand-sewn in 81 (18.7%) patients. Mean follow-up was 108.5 ± 78.4 months. At the most recent follow-up, mean Cleveland Global Quality of Life score was 0.8 ± 0.2 and numbers of daytime and night-time bowel movements were 5.3 ± 3.1 and 1.6 ± 1.3, respectively. The majority of the patients (86.8%) were fully continent or only complained of rare incontinence. Most patients had no seepage (day, 84.3%; night, 72.4%) and did not wear any pads (day, 89.3%; night, 84.3%). Most denied dietary (71.3%), social (84.8%), work (85.7%), or sexual restrictions (87.6%) at the time of last follow-up. There were 92.7% of patients who said they would undergo ileal pouch anal anastomosis again and 95.2% would recommend surgery to others. CONCLUSIONS: Restorative proctocolectomy with ileal pouch anal anastomosis can be performed in pediatric patients with acceptable morbidity and is associated with good long-term results in terms of gastrointestinal function, quality of life, and patient satisfaction.
BACKGROUND: Data regarding the long-term outcomes of restorative proctocolectomy and ileal pouch anal anastomosis including pouch function and quality of life in the pediatric population are limited in pediatric patients. STUDY DESIGN: Indications for surgery, complications, long-term function, and quality of life were evaluated in pediatric patients undergoing ileal pouch anal anastomosis. Assessment of quality of life was performed using the Cleveland Global Quality of Life score. RESULTS: There were 433 patients with a mean age of 18.04 ± 2.9 years. Final pathologic diagnoses were ulcerative colitis or indeterminate colitis (78.3%), familial adenomatous polyposis (15.7%), Crohn's disease (5.1%), and others (0.9%). There were 237 patients (54.7%) who underwent total proctocolectomy and ileal pouch anal anastomosis; 196 (45.3%) underwent initial subtotal colectomy followed by completion proctectomy with ileal pouch anal anastomosis. Anastomosis was stapled in 352 patients (81.3%) and hand-sewn in 81 (18.7%) patients. Mean follow-up was 108.5 ± 78.4 months. At the most recent follow-up, mean Cleveland Global Quality of Life score was 0.8 ± 0.2 and numbers of daytime and night-time bowel movements were 5.3 ± 3.1 and 1.6 ± 1.3, respectively. The majority of the patients (86.8%) were fully continent or only complained of rare incontinence. Most patients had no seepage (day, 84.3%; night, 72.4%) and did not wear any pads (day, 89.3%; night, 84.3%). Most denied dietary (71.3%), social (84.8%), work (85.7%), or sexual restrictions (87.6%) at the time of last follow-up. There were 92.7% of patients who said they would undergo ileal pouch anal anastomosis again and 95.2% would recommend surgery to others. CONCLUSIONS: Restorative proctocolectomy with ileal pouch anal anastomosis can be performed in pediatric patients with acceptable morbidity and is associated with good long-term results in terms of gastrointestinal function, quality of life, and patient satisfaction.
Authors: Erman Aytac; Eren Esen; H Hande Aydinli; Hasan T Kirat; David M Schwartzberg; Feza H Remzi Journal: Pediatr Surg Int Date: 2019-06-05 Impact factor: 1.827
Authors: Nathan S Rubalcava; Samir K Gadepalli; Cory N Criss; Natalie A Moreno; Jeremy Adler; James D Geiger Journal: Pediatr Surg Int Date: 2021-06-18 Impact factor: 1.827
Authors: Ellen Cowherd; Matthew D Egberg; Michael D Kappelman; Xian Zhang; Millie D Long; Amy L Lightner; Robert S Sandler; Hans H Herfarth; Edward L Barnes Journal: Inflamm Bowel Dis Date: 2022-09-01 Impact factor: 7.290
Authors: Grace C Lee; Paul M Cavallaro; Lieba R Savitt; Richard A Hodin; Hiroko Kunitake; Rocco Ricciardi; Liliana G Bordeianou Journal: Dis Colon Rectum Date: 2020-02 Impact factor: 4.412