Postoperative outcome of colectomy for pediatric patients with ulcerative colitis.
BACKGROUND
Few studies have reported on the surgical outcomes of colectomy in pediatric patients with ulcerative colitis (UC).


METHODS
We conducted a retrospective chart review of all pediatric patients diagnosed with UC who underwent colectomy at UCSF between 1980 and 2005 to identify early (within 30 days) and later complications of surgery.


RESULTS
Complete medical records were available for 31 patients [12.4 +/- 3.3 (range 6-19) years] with UC who underwent colectomy at UCSF Children's Hospital. Total colectomy with ileal pouch anal anastomosis (IPAA) was performed in 21 of the 31 patients (12 without diverting ileostomy). Five of the 31 patients had an initial colectomy with IPAA and J-pouch performed later; 4 had an initial subtotal colectomy for urgent indications. Only one of 31 had IPAA with S-pouch. The median number of early postoperative complications was 1.0; 4 required additional surgery to treat complications. The most common early complications were small intestinal obstruction in 6 (19%) and wound infection in 4 (13%). Preoperative medications included corticosteroids in 25 (81%), 6-mercaptopurine/azathioprine in 10 (32%), and 5-aminosalicylates in 19 (61%). Medication exposure was not related to postoperative complications. Late complications included pouchitis in 12 (39%), anastomotic, anal, or rectal strictures in 5 (16%), and fistulas in 5 (16%); 1 (3%) was subsequently diagnosed as having Crohn disease.


CONCLUSIONS
Postcolectomy morbidity is common among pediatric patients with UC. Preoperative medications were not associated with postoperative complications. Investigations to determine preoperative factors affecting surgical outcomes and long-term satisfaction following this surgery in a large pediatric cohort are needed.
Patton
Dana
D
Department of Pediatrics and Surgery, UCSF Children's Hospital, University of California, San Francisco, CA 94143-0136, USA.
Gupta
Neera
N
Wojcicki
Janet M
JM
Garnett
Elizabeth A
EA
Nobuhara
Kerilyn
K
Heyman
Melvin B
MB
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007412:Intestinal Fistula / Q000453:epidemiology / Q000209:etiology; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011183:Postoperative Complications; D019449:Pouchitis / Q000453:epidemiology / Q000209:etiology; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D014946:Wound Infection / Q000453:epidemiology / Q000209:etiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents
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