Pouch-anal anastomosis vs straight ileoanal anastomosis in pediatric patients: a meta-analysis.
BACKGROUND
Restorative proctocolectomy is the treatment of choice for pediatric patients with refractory colitis, inherited polyposis syndromes, and some with colonic aganglionosis. Evidence concerning the optimal method of reconstruction is, however, sparse.


METHODS
Studies comparing outcomes from ileal pouch-anal anastomosis (IPAA) and straight ileoanal anastomosis (SIAA) were identified by searching Medline, Ovid, and Embase. Suitable studies were selected and data extracted for meta-analysis.


RESULTS
Of 13 studies identified by literature search, 5 satisfied the inclusion criteria, comprising a total of 306 patients, 86 of whom (28.1%) underwent SIAA, and the remainder, IPAA. Pouch failure was more common in the SIAA group (odds ratio, 3.21; confidence interval, 1.24-8.34), as were abdominal salvage procedures (odds ratio, 9.5; confidence interval, 3.14-28.77). Short-term adverse events were similar between the 2 groups, with the exception of perianal sepsis, the higher frequency of which, in SIAA, just reached statistical significance. Bowel frequency was lower in the IPAA patients, although few studies presented functional data in a comparable form.


CONCLUSIONS
There are few good-quality studies that compare the outcomes from SIAA and IPAA, meaning that caution should be exercised in the generalization of the results of this meta-analysis, which suggests pouch procedures to be favorable in terms of reconstruction survival and functional outcome.
Tilney
Henry S
HS
Department of Surgical Oncology and Technology, Imperial College London, St. Mary's Hospital, W2 1NY London, UK.
Constantinides
Vasilis
V
Ioannides
Adonis S
AS
Tekkis
Paris P
PP
Darzi
Ara W
AW
Haddad
Munther J
MJ
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D006801:Humans; D016737:Proctocolectomy, Restorative / Q000379:methods*; D016896:Treatment Outcome