Single-center review of staged restorative proctectomy for ulcerative colitis
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Read the article on jpedsurg.org ↗Article · Nov 2019 · 1 min read
In brief
In brief
This 20-year retrospective study of 39 pediatric UC patients undergoing staged restorative proctectomy found two-thirds experienced complications requiring additional surgery, with bowel obstruction most common. Notably, 20% developed Crohn's disease post-operatively, though most retained functional pouches with median 4 bowel movements daily at 1-2 years follow-up.
Written by the GCMD Library team from the article.
Aim
The purpose of this study was review results of pediatric patients undergoing total colectomy and restorative surgery for ulcerative colitis (UC) in a regional pediatric surgical center.
Methods
A retrospective case note analysis of consecutive patients undergoing colectomy for UC between 1995 and 2014 was performed. Early complications were defined as occurring within 30 days of surgery. Data was expressed as median (range).
Results
Of 39 children who had colectomy (59% female), 21 J-pouch procedures (20 three-staged) were undertaken at our center at median age 13 years (6–17 years). Length of stay (LOS) after colectomy was 8 days (6–21) with five early and eight late complications. LOS after J-pouch ileo-anal anastomosis was 7 days (5–19 days) with two early and three late complications. After ileostomy closure LOS was 6 days (4–16 days) with three early and two late complications. The most frequent complication following each surgical stage was bowel obstruction. There was only one pouch loss, which was secondary to development of Crohn's disease (CD), and three other patients with J-pouches also subsequently developed CD 1.5 to 10 years after their original colectomy but retained their pouch. Bowel frequency at 1–2 years post J-pouch in 14 patients was a median of 4 per 24 h (2–7 per 24 h).
Conclusion
When all three postoperative stages were considered, two thirds of patients developed complications resulting in 15 additional visits to the operating theater. One in five patients subsequently developed CD after J-pouch. This should be carefully considered during pre-operative counseling.
Type of Study
Retrospective Study.
Level of Evidence
Level IV.