Current surgical practice in pediatric ulcerative colitis: A systematic review
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In brief
In brief
Systematic review of 568 pediatric UC patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, comparing outcomes across one-, two-, and three-stage procedures. Higher disease activity scores correlated with staged approaches, though staging did not impact quality of life.
Written by the GCMD Library team from the article.
Background
Surgical management of adult ulcerative colitis (UC) is well-studied, but not readily applicable to children. Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA), performed as one-, two-, or three-stage procedure, is preferred in pediatric patients with adequate anal sphincter function.
Purpose
- 1)Compare the outcomes of surgical management in pediatric UC.
- 2)Identify factors influencing choice of staged procedures for RPC-IPAA, and their associated complications (including pouch failure rates).
Methods
Systematic review of Cochrane Register of Controlled Trials, PubMed, and EMBASE databases was conducted (January 1987–December 2016), in accordance with PRISMA.
Results
Twelve retrospective studies were identified (568 patients total); 31, 334, and 203 patients underwent one-, two-, and three-stage procedures, respectively. Median study size was 31 patients (range 10–202), median age was 13 years (range 2–21), median follow-up was 4 years (range 0.08–16). Postoperative complications included pouchitis, bowel obstruction, stricture, fistula, pouch failure, anastomotic leak, and wound infections. Calcineurin inhibitor usage improved pediatric ulcerative colitis activity index (PUCAI) score. Higher PUCAI scores correlated with likelihood of staged procedures. Number of stages did not restrict quality of life.
Conclusions
Paucity of data exists, comparing preoperative factors leading to staged procedures in pediatric UC. This systematic review identifies an area for future studies.
Level of evidence
II.