Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative Colitis: Does it need diverting? | Retrospective | IBM® Database | 2000 - 2019 | 317 patients | 238 IPAA + DI | 79 Only IPAA | *DI = Diverting Ileostomy | RESULTS | Conclusion: | Creating a DI requires an extra surgical procedure for closure and does not lead to a reduction in negative outcomes. | There was NO significant difference in | 11.3% Surgical Site Infections 10.1% p = 0.67 | 2.1% Intra-abdominal drainage 3.8% p = 0.39 | 19.3% 30-day readmission 16.5% p = 0.39 | https://www.jpedsurg.org/article/S0022-3468(23)00444-X/ | Source: Adams U et. al. | Department of Surgery, University of North Carolina at Chapel Hill, NC, USA | @StayCurrentMD | @gigenace | Cincinnati Children's | Journal of Pediatric Surgery
The Role of Diversion During Ileal Pouch Anal Anastomosis (IPAA) Creation in Pediatric Ulcerative Colitis JPS
Infographic · Feb 2024 · 1 min read
In brief
In brief
Retrospective analysis of 317 pediatric UC patients undergoing IPAA found that diverting ileostomy at time of pouch creation did not reduce 30-day complications including SSI, readmissions, or need for drainage procedures, despite requiring additional surgery for closure.
- Diverting ileostomy at IPAA creation did not reduce 30-day complications (SSI, abscess, readmission) in pediatric UC patients.
- SSI rates were similar between IPAA alone (10.1%) and IPAA with diversion (11.3%), p=0.67.
- Routine diversion adds a second surgery without clear benefit; selective use may be warranted in high-risk subgroups.
- Multi-center studies needed to identify which pediatric UC patients truly benefit from protective ileostomy at IPAA.
- In refractory/severe pediatric UC, diversion does not appear protective despite theoretical anastomotic advantages.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with icons of an ostomy bag and intestines to illustrate patient groups. A flowchart shows 317 patients split into two groups (238 with diverting ileostomy, 79 without). Results are displayed in a table format with red percentages for the IPAA+DI group and gray percentages for the IPAA-only group, comparing three outcomes. A yellow conclusion box appears on the right side.
New infographic from Journal of Pediatric Surgery by Cecilia Gigena
"The Role of Diversion During Ileal Pouch Anal Anastomosis (IPAA) Creation in Pediatric Ulcerative Colitis"
Authors: Ursula Adams, Chris Agala, Topher McCauley, Laura Burkbauer, Jonathan Stem, Ajay Gulati, Matthew Egberg, Michael Phillips
Full article: https://www.jpedsurg.org/article/S0022-3468(23)00444-X/abstract
Abstract
Introduction
In pediatric ulcerative colitis (UC), surgery is often postponed until disease is life-threatening or refractory to immune suppression. In these settings, diverting ileostomy (DI) is theorized to have a protective effect on the new anastomosis. However, analyses have been performed only in single-institution series and the true impact of performing DI at the time of IPAA on postoperative outcomes is unclear.
Methods
We performed a retrospective cohort study using claims data from the International Business Machines (IBM) MarketScan® database. Patients were sorted to the DI group if they carried a CPT code for ostomy closure within 6 months of index procedure. We examined demographics, preoperative risk factors, and performed regression analysis to compare 30-day postoperative outcomes between groups.
Results
We identified 317 patients ≤18yo that underwent IPAA procedure and met inclusion criteria from 2000 to 2019. Of these, 238 patients were assigned to the IPAA + DI cohort and 79 patients were assigned to the IPAA cohort.
Adverse outcomes were comparable between cohorts. Surgical site infection (SSI) rates between IPAA and IPAA + DI were 10.1 vs. 11.3% (p = 0.67). Rates of intra-abdominal drainage procedures were 3.8 vs. 2.1% (p = 0.39). The rates of 30-day readmissions were 16.5 vs. 19.3% (p = 0.39). Creation of a DI was not associated with higher odds of 30-day readmission (OR = 1.4, p = 0.31).
Conclusion
Creating a DI necessitates an additional surgery for closure and is not associated with decreased adverse outcomes. There is still a role for multicenter studies to define which patient populations may benefit from diversion.