Сomplications and functional outcomes after restorative proctocolectomy with ileal pouch–anal anastomosis in children: A single-center experience

Cover Page

Cite item

Full Text

Abstract

BACKGROUND: Restorative proctocolectomy with ileal pouch–anal anastomosis is a prominent treatment for adult patients with ulcerative colitis and familial adenomatous polyposis, with satisfactory functional outcomes. In literature, that technique in pediatric practice is described; however, in the domestic literature, there is no mention of ileal pouch–anal anastomosis in children.

AIM: This study aimed to examine the outcomes of ileal pouch–anal anastomosis in pediatric patients.

MATERIALS AND METHODS: The study comprised 33 patients with an ileal pouch–anal anastomosis between January 2019 and June 2023. At the time of the ileal pouch–anal anastomosis, the average age was 13 (±5) yr. Patients were followed for an average of 17 (±14) months.

RESULTS: Patients with ulcerative colitis underwent three-stage surgical interventions more often than patients with another diagnosis (90% vs. 4%, p < 0.0001), and the mean duration of surgery in ulcerative colitis patients was shorter than in patients with polyposis syndromes or total agangliosis: 173 (±57) min versus 280 (±73) min. Late complications were reported in five (15%) patients undergoing ileal pouch–anal anastomosis. After the ileal pouch–anal anastomosis, analysis of patient questionnaires revealed that children had satisfactory functional results.

CONCLUSIONS: Several encouraging studies have confirmed good functional outcomes after ileal pouch–anal anastomosis. Our findings suggest that ileal pouch–anal anastomosis in children is associated with favorable results.

About the authors

Linara R. Khabibullina

Russian Children’s Clinical Hospital

Author for correspondence.
Email: habibull.lin@yandex.ru
ORCID iD: 0000-0002-1515-0699
SPIN-code: 7241-8029

Pediatric Surgeon of the Surgeon Department

Russian Federation, Moscow

Alexander Yu. Razumovsky

Pirogov Russian National Research Medical University

Email: 1595105@mail.ru
ORCID iD: 0000-0002-9497-4070
SPIN-code: 3600-4701

MD, Dr. Sci. (Med.), Professor, Correspondent Member of Russian Academy of Sciences, Head of Pediatric Surgery Department, Pediatric Surgeon

Russian Federation, Moscow

Olga V. Shсherbakova

Russian Children’s Clinical Hospital

Email: Shcherbakova_o_v@rdkb.ru
ORCID iD: 0000-0002-8514-3080
SPIN-code: 3478-8606

MD, Dr. Sci. (Med.), Head of Department of Pediactric Surgery, Pediatric Surgeon

Russian Federation, Moscow

References

  1. Fazio VW, Kiran RP, Remzi FH, et al. Ileal pouch anal anastomosis. Ann Surg. 2013;257(4):679–685. doi: 10.1097/SLA.0b013e31827d99a2
  2. Hassan Y, Connel WR, Rawal A, Wright EK. Review of long-term complications and functional outcomes of ileoanal pouch procedures in patients with inflammatory bowel disease. ANZ J Surg. 2023;93(6):1503–1509. doi: 10.1111/ans.18490
  3. Runde J, Erondu A, Akiyama S, et al. Outcomes of ileoanal pouch anastomosis in pediatric ulcerative colitis are worse in the modern era: A time trend analysis outcomes following ileal pouch-anal anastomosis in pediatric ulcerative colitis. Inflamm Bowel Dis. 2022;28(9):1386–1394. doi: 10.1093/ibd/izab319
  4. Hyer W, Cohen S, Attard T, et al. Management of familial adenomatous polyposis in children and adolescents: position paper from the ESPGHAN Polyposis Working Group. J Pediatr Gastroenterol Nutr. 2019;68(3):428–441. doi: 10.1097/MPG.0000000000002247
  5. Stenström P, Kyrklund K, Bräutigam M, et al. Total colonic aganglionosis: multicentre study of surgical treatment and patient-reported outcomes up to adulthood. BJS open. 2020;4(5):943–953. doi: 10.1002/bjs5.50317
  6. Kuenzig ME, Fung SG, Marderfeld L, et al. Twenty-first century trends in the global epidemiology of pediatric-onset inflammatory bowel disease: systematic review. Gastroenterology. 2022;162(4):1147–1159. doi: 10.1053/j.gastro.2021.12.282
  7. Rinawi F, Assa A, Eliakim R, et al. Risk of colectomy in patients with pediatric-onset ulcerative colitis. J Pediatr Gastroenterol Nutr. 2017;65(4):410–415. doi: 10.1097/MPG.0000000000001545
  8. Hyams JS, Brimacombe M, Haberman Y, et al. Clinical and host biological factors predict colectomy risk in children newly diagnosed with ulcerative colitis. Inflamm Bowel Dis. 2022;28(2):151–160. doi: 10.1093/ibd/izab061
  9. Turner D, Ruemmele FM, Esther O-M. Management of paediatric ulcerative colitis, Part 2: Acute severe colitis — an evidence-based consensus guideline from the European Crohn’s and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutrit. 2018;67(2):292–310. doi: 10.1097/MPG.0000000000002036
  10. Tsukanov AS, Shelygin YA, Semenov DA, et al. Lynch syndrome: current status. Medical Genetics. 2017;16(2):11–18. (In Russ.)
  11. Heuthorst L, Wasmann K, Reijntjes MA, et al. Ileal pouch-anal anastomosis complications and pouch failure a systematic review and meta-analysis. Ann Surg Open. 2021;2(2):e074. doi: 10.1097/AS9.0000000000000074
  12. Lee GC, Deere SE, Kunitake H, et al. Comparable perioperative outcomes, long-term outcomes, and quality of life in a retrospective analysis of ulcerative colitis patients following 2-stage versus 3-stage proctocolectomy with ileal pouch-anal anastomosis. Int J Colorectal Dis. 2019;34:491–499. doi: 10.1007/s00384-018-03221-x
  13. Achkasov SI, Kulikov AE, Mingazov AF, et al. Pouch failure in patients with ulcerative colitis. Koloproktologia. 2022;21(3):10–18. (In Russ.) doi: 10.33878/2073-7556-2022-21-3-10-18
  14. Lovegrove RE, Fazio VW, Remzi FH, et al. Development of a pouch functional score following restorative proctocolectomy. Br J Surg. 2010;97(6):945–951. doi: 10.1002/bjs.7021
  15. Lightner AL, Alsughayer A, Wang Z, et al. Short- and long-term outcomes after ileal pouch anal anastomosis in pediatric patients: a systematic review. Inflamm Bowel Dis. 2019;25(7):1152–1168. doi: 10.1093/ibd/izy375
  16. Bismar N, Patel AS, Schindel DT. Does age affect surgical outcomes after ileal pouch-anal anastomosis in children? J Surg Res. 2019;237:61–66. doi: 10.1016/j.jss.2019.01.004
  17. Shelygin YuA, Fomenko AYu, Titov AYu, et al. Sphincterometry gradation of anal sphincter insufficiency. Koloproctologia. 2016;(4):54–59. (In Russ.)
  18. Berndtsson I, Öresland T. Quality of life before and after proctocolectomy and IPAA in patients with ulcerative proctocolitis — a prospective study. Colorectal Dis. 2003;5:173–179. doi: 10.1046/j.1463-1318.2003.00455.x
  19. Gonzales DO, Nwomeh BS. Complications in children with ulcerative colitis undergoing ileal pouch-anal anastomosis. Semin Pediatr Surg. 2017;26(6):384–390. doi: 10.1053/j.sempedsurg.2017.10.008
  20. Ikeuchi H, Uchinо M, Sugitа A, et al. Long-term outcomes following restorative proctocolectomy ileal pouch-anal anastomosis in pediatric ulcerative colitis patients: Multicenter national study in Japan. Ann Gastroenterol Surg. 2018;2(6):428–433. doi: 10.1002/ags3.12198
  21. Drews JD, Onwuka EA, Fisher JG, et al. Complications after proctocolectomy and ileal pouch-anal anastomosis in pediatric patients: A systematic review. J Pediatr Surg. 2019;54(7):1331–1339. doi: 10.1016/j.jpedsurg.2018.08.047.
  22. Diederen K, Sahami SS, Tabbers MM, et al. Outcome after restorative proctocolectomy and ileal pouch-anal anastomosis in children and adults. Br J Surg. 2017;104(12):1640–1647. doi: 10.1002/bjs.10678
  23. Nyholm I, Hukkinen M, Koivusalo A, et al. Long-term single-centre outcomes after proctocolectomy with ileoanal anastomosis for paediatric ulcerative colitis. J Crohn’s Colitis. 2019;13(3):302–308. doi: 10.1093/ecco-jcc/jjy175
  24. Polites SF, Zarroug AE, Moir CR, Potter DD. Single-incision laparoscopic ileal pouch-anal anastomosis in children — how does it compare to a laparoscopic-assisted approach? J Laparoendosc Adv Surg Tech. 2015;25(2):167–171. doi: 10.1089/lap.2014.0297
  25. Shannon A, Eng K, Kay M, et al. Long term follow up of ileal pouch anal anastomosis in a large cohort of pediatric and young adult patients with ulcerative colitis. J Pediatr Surg. 2016;51(7):1181–1186. doi: 10.1016/j.jpedsurg.2015.12.012
  26. McKenna NP, Mathis KL, Khasawneh MA, et al. Obese patients undergoing Ileal pouch-anal anastomosis: short- and long-term surgical outcomes. Inflamm Bowel Dis. 2017;23(12):2142–2146. doi: 10.1097/MIB.0000000000001238
  27. Magro F, Gionchetti P, Eliakim R, et al. Third european evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohn’s Colitis. 2017;11(6):649–670. doi: 10.1093/ecco-jcc/jjx008
  28. Dukleska K, Berman L, Aka AA, et al. Short-term outcomes in children undergoing restorative proctocolectomy with ileal-pouch anal anastomosis. J Pediatr Surg. 2018;53(6):115–1159. doi: 10.1016/j.jpedsurg.2018.02.075
  29. Huang CC, Rescorla FJ, Landman MP. Clinical outcomes after ileal pouch-anal anastomosis in pediatric patients. J Surg Res. 2019;234:72–76. doi: 10.1016/j.jss.2018.09.011

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Figure. Schematic view of J-pouch: 1 — J-pouch; 2 — ileal pouch–anal anastomosis; 3 — anal sphincter; 4 — linea dentate; and 5 — anal canal

Download (61KB)
Indexing metadata

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies