Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
ILEAL POUCH-ANAL ANASTOMOSIS IN CHILDREN WITH ULCERATIVE COLITIS: LONG-TERM FOLLOW-UP
The study is a retrospective review of all patients less than 22 years of age with Ulcerative Colitis (UC) who had colectomy and ileal pouch-anal anastomosis (IPAA) between 1982-1996. The purpose of the review was to evaluate the long-term outcome of IPAA in children with UC. Demographic, preoperative and surgical data were abstracted from the medical records and quality of life information was obtained from patient interviews. 176 children and adolescents were identified during the study period with a median age of 15 years. Follow-up data was available in 158 patients. The principal indication for surgery was intractable symptoms despite vigorous medical therapy. Median follow-up was 7 years. Small bowel obstruction was the most common early complication occurred in 20 patients (12.8%); 65% of them required surgical intervention. Late complications included pouchitis in 95 (60%) patients and pelvic infection in 40 (25%). The cumulative risk for pouchitis was up to 60% at 7 years compared to 15% at 2 years in our initial survey. Twenty-three patients had chronic pouchitis (14.5%); 6 patients had their pouch removed. The long-term surgical failure rate was 9.4% occurred in 15 patients. They had end-ileostomy with excision or permanent bypass of the pouch. Eleven patients were diagnosed as Crohn's disease on the basis of further small bowel disease or recurrent fistula who had functioning pouch but on immunosuppressive therapy. 77% of patients were "very satisfied" with their surgical outcome compared to 92% in our initial survey. In conclusion, IPAA is still an effective surgical procedure for patients with UC who are unresponsive to conventional medical therapy. There is an increased risk of pouchitis, surgical failure and more frequent diagnosis of Crohn's disease with longer follow-up. Chronic pouchitis and recurrent pelvic infection were risk factors for pouch failure. These issues should be clearly discussed with patients preoperatively before considering pelvic pouch surgery.
Abdominal Pain/IBD/Outcomes© 1998 Lippincott Williams & Wilkins, Inc.