title: Pediatric chronic ulcerative colitis: does infliximab increase post-ileal pouch anal anastomosis complications?
abstract: BACKGROUND
  Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is a common surgical approach to chronic ulcerative colitis (CUC). Preoperative use of Infliximab (IFX) has raised concern of increased postoperative complications. We sought to compare outcomes of pediatric patients (≤ 18 years) who were treated with IFX before IPAA to those who did not.
  
  
  METHODS
  Patients (≤ 18 years of age) who underwent IPAA from 2003 to 2008 for CUC were included, and their records were retrospectively reviewed for preoperative medications, operative technique, and 1-year postoperative complications (leak, wound infection, small bowel obstruction, pouchitis). Subjects were divided into 2 groups--those who received IFX preoperatively and those who did not.
  
  
  RESULTS
  Eleven patients received IFX preoperatively, and 27 children did not. All complications following IPAA were more frequent in the IFX group compared to controls (55% vs 26%). Small bowel obstruction was significantly higher in the IFX group (55% vs 7%). Long-term complications occurred in 64% of the IFX group and 61% of the controls.
  
  
  CONCLUSIONS
  Children that were treated with IFX prior to IPAA suffered twice as many postoperative complications. Long-term outcomes are similar. Currently, we recommend colectomy with end ileostomy for patients that receive IFX within 8 weeks of colectomy for CUC.
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Raelene
authors.initials: R
authors.lastname: Kennedy
authors.forename: D Dean
authors.initials: DD
authors.lastname: Potter
authors.forename: Christopher
authors.initials: C
authors.lastname: Moir
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
authors.forename: William
authors.initials: W
authors.lastname: Faubion
authors.forename: Jeanne
authors.initials: J
authors.lastname: Tung
mesh_terms: D000714:Anastomosis, Surgical; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D002648:Child; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D000069285:Infliximab; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab