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

4 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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