Joseph D Drews1, Ekene A Onwuka2, Jeremy G Fisher3, Justin T Huntington4, Michał Dutkiewicz5, Agata Nogalska6, Benedict C Nwomeh7. 1. Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205; Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH, USA 43210. Electronic address: joseph.drews@nationwidechildrens.org. 2. Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205; Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH, USA 43210. Electronic address: ekenedilichukwu.onwuka@osumc.edu. 3. Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205. Electronic address: jeremy.fisher@nationwidechildrens.org. 4. Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205. Electronic address: justin.huntington2@nationwidechildrens.org. 5. Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205. Electronic address: michal.dutkiewicz93@gmail.com. 6. Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205. Electronic address: a.k.nogalska@gmail.com. 7. Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA 43205; Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH, USA 43210. Electronic address: benedict.nwomeh@nationwidechildrens.org.
Abstract
BACKGROUND/ PURPOSE: Colectomy with ileal pouch-anal anastomosis (IPAA) is the standard of care for patients with familial adenomatous polyposis (FAP) and refractory ulcerative colitis (UC). The rates of postoperative complications are not well established in children. The objective of this systematic review is to establish benchmark data for morbidity after pediatric IPAA. METHODS: PubMed, Embase, and The Cochrane Library were searched for studies of colectomy with IPAA in patients ≤21 years old. UC studies were limited to the anti-tumor necrosis factor-α agents era (1998-present). All postoperative complications were extracted. RESULTS: Thirteen studies met the inclusion criteria (763 patients). Compared to patients with FAP, UC patients had a higher prevalence of pouch loss (10.6% vs. 1.5%). Other major complications such as anastomotic leak, abscess, and fistula were uncommon (mean prevalence 4.9%, 4.2%, and 5.0%, respectively, for patients with UC; 8.7%, 4.2%, and 4.3% for FAP). The most frequent complication was pouchitis (36.4% of UC patients). CONCLUSIONS: Devastating complications from colectomy and IPAA are rare, but patients with UC have poorer outcomes than those with FAP. Much of the morbidity may therefore stem from patient or disease factors. Multicenter, prospective studies are needed to identify modifiable risks in patients with UC undergoing IPAA. LEVEL OF EVIDENCE: Prognostic, level II.
BACKGROUND/ PURPOSE: Colectomy with ileal pouch-anal anastomosis (IPAA) is the standard of care for patients with familial adenomatous polyposis (FAP) and refractory ulcerative colitis (UC). The rates of postoperative complications are not well established in children. The objective of this systematic review is to establish benchmark data for morbidity after pediatric IPAA. METHODS: PubMed, Embase, and The Cochrane Library were searched for studies of colectomy with IPAA in patients ≤21 years old. UC studies were limited to the anti-tumornecrosis factor-α agents era (1998-present). All postoperative complications were extracted. RESULTS: Thirteen studies met the inclusion criteria (763 patients). Compared to patients with FAP, UC patients had a higher prevalence of pouch loss (10.6% vs. 1.5%). Other major complications such as anastomotic leak, abscess, and fistula were uncommon (mean prevalence 4.9%, 4.2%, and 5.0%, respectively, for patients with UC; 8.7%, 4.2%, and 4.3% for FAP). The most frequent complication was pouchitis (36.4% of UC patients). CONCLUSIONS: Devastating complications from colectomy and IPAA are rare, but patients with UC have poorer outcomes than those with FAP. Much of the morbidity may therefore stem from patient or disease factors. Multicenter, prospective studies are needed to identify modifiable risks in patients with UC undergoing IPAA. LEVEL OF EVIDENCE: Prognostic, level II.
Authors: Brent A Willobee; Jennifer A Nguyen; Anthony Ferrantella; Hallie J Quiroz; Anthony R Hogan; Ann-Christina Brady; Samir Pandya; Amber H Langshaw; Juan E Sola; Chad M Thorson; Eduardo A Perez Journal: Transl Gastroenterol Hepatol Date: 2021-07-25
Authors: Joseph Runde; Amarachi Erondu; Shintaro Akiyama; Cindy Traboulsi; Victoria Rai; Laura R Glick; Yangtian Yi; Jacob E Ollech; Russell D Cohen; Kinga B Skowron; Roger D Hurst; Konstatin Umanskiy; Benjamin D Shogan; Neil H Hyman; Michele A Rubin; Sushila R Dalal; Atsushi Sakuraba; Joel Pekow; Eugene B Chang; David T Rubin Journal: Inflamm Bowel Dis Date: 2022-09-01 Impact factor: 7.290
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