Short- And long-term outcomes after ileal pouch anal anastomosis in pediatric patients: A systematic review

Amy Lightner, Ahmad Alsughayer, Zhen Wang, Nicholas P. McKenna, Mohamed O. Seisa, Christopher Moir

Research output: Contribution to journalArticle

Abstract

Background: Restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) has become the procedures of choice for restoration of intestinal continuity in ulcerative colitis or familial adenomatous polyposis. This systematic review aims to assess short-term postoperative and long-term functional outcomes in pediatric patients undergoing IPAA. Methods: A literature search was performed for all publications of pediatric IPAA in which short- and long-term outcomes were reported. Papers were excluded based on title, abstract, and full-length review. Data collection included patient demographics, medication use preoperatively, operative approach, 30-day postoperative outcomes, long-term functional outcomes (to maximal date of follow-up), and pouch failure rate. Outcomes were compared in those patients with and without perioperative corticosteroid exposure. Study quality and risk of bias was assessed using the Newcastle-Ottawa Scale as all studies were cohort studies. Results: Of 710 records reviewed, 42 full papers were included in the analysis. Rates of superficial surgical site infection, pelvic sepsis, ileus, and small bowel obstruction at <30 days were 10%, 11%, 10%, and 14%, respectively. Rates of pouchitis, stricture, chronic fistula tract, incontinence, and pouch failure were 30%, 17%, 12%, 20%, and 8%, respectively, at 37-109 months of follow-up; incontinence was significantly higher in those exposed to corticosteroids preoperatively (52% vs 20%; P < 0.001). The median daytime, nighttime, and 24-hour stool frequency were 5.3, 1.4, and 5 bowel movements, respectively. Conclusions: IPAA is safe with good long-term functional outcomes in pediatric patients.

Original languageEnglish (US)
Pages (from-to)1152-1168
Number of pages17
JournalInflammatory bowel diseases
Volume25
Issue number7
DOIs
StatePublished - Jun 18 2019

Fingerprint

Colonic Pouches
Pediatrics
Adrenal Cortex Hormones
Restorative Proctocolectomy
Pouchitis
Surgical Wound Infection
Adenomatous Polyposis Coli
Ileus
Ulcerative Colitis
Fistula
Publications
Sepsis
Pathologic Constriction
Cohort Studies
Demography

Keywords

  • Familial adenomatous polyposis
  • Ileal pouch anal anastomosis (IPAA)
  • Pediatric
  • Postoperative function
  • Ulcerative colitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Short- And long-term outcomes after ileal pouch anal anastomosis in pediatric patients : A systematic review. / Lightner, Amy; Alsughayer, Ahmad; Wang, Zhen; McKenna, Nicholas P.; Seisa, Mohamed O.; Moir, Christopher.

In: Inflammatory bowel diseases, Vol. 25, No. 7, 18.06.2019, p. 1152-1168.

Research output: Contribution to journalArticle

Lightner, A, Alsughayer, A, Wang, Z, McKenna, NP, Seisa, MO & Moir, C 2019, 'Short- And long-term outcomes after ileal pouch anal anastomosis in pediatric patients: A systematic review', Inflammatory bowel diseases, vol. 25, no. 7, pp. 1152-1168. https://doi.org/10.1093/ibd/izy375
Lightner, Amy ; Alsughayer, Ahmad ; Wang, Zhen ; McKenna, Nicholas P. ; Seisa, Mohamed O. ; Moir, Christopher. / Short- And long-term outcomes after ileal pouch anal anastomosis in pediatric patients : A systematic review. In: Inflammatory bowel diseases. 2019 ; Vol. 25, No. 7. pp. 1152-1168.
@article{29122c071a7544ee96de13d303c24ded,
title = "Short- And long-term outcomes after ileal pouch anal anastomosis in pediatric patients: A systematic review",
abstract = "Background: Restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) has become the procedures of choice for restoration of intestinal continuity in ulcerative colitis or familial adenomatous polyposis. This systematic review aims to assess short-term postoperative and long-term functional outcomes in pediatric patients undergoing IPAA. Methods: A literature search was performed for all publications of pediatric IPAA in which short- and long-term outcomes were reported. Papers were excluded based on title, abstract, and full-length review. Data collection included patient demographics, medication use preoperatively, operative approach, 30-day postoperative outcomes, long-term functional outcomes (to maximal date of follow-up), and pouch failure rate. Outcomes were compared in those patients with and without perioperative corticosteroid exposure. Study quality and risk of bias was assessed using the Newcastle-Ottawa Scale as all studies were cohort studies. Results: Of 710 records reviewed, 42 full papers were included in the analysis. Rates of superficial surgical site infection, pelvic sepsis, ileus, and small bowel obstruction at <30 days were 10{\%}, 11{\%}, 10{\%}, and 14{\%}, respectively. Rates of pouchitis, stricture, chronic fistula tract, incontinence, and pouch failure were 30{\%}, 17{\%}, 12{\%}, 20{\%}, and 8{\%}, respectively, at 37-109 months of follow-up; incontinence was significantly higher in those exposed to corticosteroids preoperatively (52{\%} vs 20{\%}; P < 0.001). The median daytime, nighttime, and 24-hour stool frequency were 5.3, 1.4, and 5 bowel movements, respectively. Conclusions: IPAA is safe with good long-term functional outcomes in pediatric patients.",
keywords = "Familial adenomatous polyposis, Ileal pouch anal anastomosis (IPAA), Pediatric, Postoperative function, Ulcerative colitis",
author = "Amy Lightner and Ahmad Alsughayer and Zhen Wang and McKenna, {Nicholas P.} and Seisa, {Mohamed O.} and Christopher Moir",
year = "2019",
month = "6",
day = "18",
doi = "10.1093/ibd/izy375",
language = "English (US)",
volume = "25",
pages = "1152--1168",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "John Wiley and Sons Inc.",
number = "7",

}

TY - JOUR

T1 - Short- And long-term outcomes after ileal pouch anal anastomosis in pediatric patients

T2 - A systematic review

AU - Lightner, Amy

AU - Alsughayer, Ahmad

AU - Wang, Zhen

AU - McKenna, Nicholas P.

AU - Seisa, Mohamed O.

AU - Moir, Christopher

PY - 2019/6/18

Y1 - 2019/6/18

N2 - Background: Restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) has become the procedures of choice for restoration of intestinal continuity in ulcerative colitis or familial adenomatous polyposis. This systematic review aims to assess short-term postoperative and long-term functional outcomes in pediatric patients undergoing IPAA. Methods: A literature search was performed for all publications of pediatric IPAA in which short- and long-term outcomes were reported. Papers were excluded based on title, abstract, and full-length review. Data collection included patient demographics, medication use preoperatively, operative approach, 30-day postoperative outcomes, long-term functional outcomes (to maximal date of follow-up), and pouch failure rate. Outcomes were compared in those patients with and without perioperative corticosteroid exposure. Study quality and risk of bias was assessed using the Newcastle-Ottawa Scale as all studies were cohort studies. Results: Of 710 records reviewed, 42 full papers were included in the analysis. Rates of superficial surgical site infection, pelvic sepsis, ileus, and small bowel obstruction at <30 days were 10%, 11%, 10%, and 14%, respectively. Rates of pouchitis, stricture, chronic fistula tract, incontinence, and pouch failure were 30%, 17%, 12%, 20%, and 8%, respectively, at 37-109 months of follow-up; incontinence was significantly higher in those exposed to corticosteroids preoperatively (52% vs 20%; P < 0.001). The median daytime, nighttime, and 24-hour stool frequency were 5.3, 1.4, and 5 bowel movements, respectively. Conclusions: IPAA is safe with good long-term functional outcomes in pediatric patients.

AB - Background: Restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) has become the procedures of choice for restoration of intestinal continuity in ulcerative colitis or familial adenomatous polyposis. This systematic review aims to assess short-term postoperative and long-term functional outcomes in pediatric patients undergoing IPAA. Methods: A literature search was performed for all publications of pediatric IPAA in which short- and long-term outcomes were reported. Papers were excluded based on title, abstract, and full-length review. Data collection included patient demographics, medication use preoperatively, operative approach, 30-day postoperative outcomes, long-term functional outcomes (to maximal date of follow-up), and pouch failure rate. Outcomes were compared in those patients with and without perioperative corticosteroid exposure. Study quality and risk of bias was assessed using the Newcastle-Ottawa Scale as all studies were cohort studies. Results: Of 710 records reviewed, 42 full papers were included in the analysis. Rates of superficial surgical site infection, pelvic sepsis, ileus, and small bowel obstruction at <30 days were 10%, 11%, 10%, and 14%, respectively. Rates of pouchitis, stricture, chronic fistula tract, incontinence, and pouch failure were 30%, 17%, 12%, 20%, and 8%, respectively, at 37-109 months of follow-up; incontinence was significantly higher in those exposed to corticosteroids preoperatively (52% vs 20%; P < 0.001). The median daytime, nighttime, and 24-hour stool frequency were 5.3, 1.4, and 5 bowel movements, respectively. Conclusions: IPAA is safe with good long-term functional outcomes in pediatric patients.

KW - Familial adenomatous polyposis

KW - Ileal pouch anal anastomosis (IPAA)

KW - Pediatric

KW - Postoperative function

KW - Ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=85068389027&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068389027&partnerID=8YFLogxK

U2 - 10.1093/ibd/izy375

DO - 10.1093/ibd/izy375

M3 - Article

C2 - 30668719

AN - SCOPUS:85068389027

VL - 25

SP - 1152

EP - 1168

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 7

ER -