Early Ileal pouch anal anastomosis for ulcerative colitis in children: similar outcome to delayed pouch construction despite higher co-morbidity
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In brief
In brief
Comparative study of 371 pediatric UC patients undergoing IPAA found no difference in adverse events between early (2-stage) and delayed (3-stage) pouch construction, despite higher steroid and immunosuppressant exposure in the early group. Results suggest early pouch creation is safe in children when clinically indicated.
Written by the GCMD Library team from the article.
Abstract
Background
Children with ulcerative colitis (UC) may undergo a staged approach for restorative proctocolectomy and ileal pouch anal anastomosis (IPAA). Previous studies in adults suggest a decreased morbidity with delayed pouch creation, but pediatric studies are limited. We compared outcomes for delayed versus early pouch construction in children.
Methods
Patients with UC undergoing IPAA were selected from the National Surgical Quality Improvement Program Pediatric database from 2012 to 2018. Patients were categorized as early (2-stage) or delayed (3-stage) pouch construction based on Current Procedural Terminology codes. Our primary outcome was any adverse event. We used a multivariable logistic regression model to assess the relationship between timing of pouch creation and adverse events.
Results
We identified 371 children who underwent IPAA: 157 (42.3%) had early pouch creation and 214 (57.6%) had a delayed pouch. Those with an early pouch creation were more likely to have exposure to immunosuppressants (11% vs. 5%, p = 0.017) and steroids (30% vs. 10%, p < 0.001) at the time of surgery. After controlling for patient characteristics, there were no significant differences in adverse events between the two groups.
Conclusions
Children undergoing early pouch creation have increased exposure to steroids and immune suppressants; nevertheless, no differences in adverse events were identified.
Level of evidence
II