Functional outcomes and complications after restorative proctocolectomy and ileal pouch anal anastomosis in the pediatric population.
BACKGROUND
Data regarding the long-term outcomes of restorative proctocolectomy and ileal pouch anal anastomosis including pouch function and quality of life in the pediatric population are limited in pediatric patients.


METHODS
Indications for surgery, complications, long-term function, and quality of life were evaluated in pediatric patients undergoing ileal pouch anal anastomosis. Assessment of quality of life was performed using the Cleveland Global Quality of Life score.


RESULTS
There were 433 patients with a mean age of 18.04 ± 2.9 years. Final pathologic diagnoses were ulcerative colitis or indeterminate colitis (78.3%), familial adenomatous polyposis (15.7%), Crohn's disease (5.1%), and others (0.9%). There were 237 patients (54.7%) who underwent total proctocolectomy and ileal pouch anal anastomosis; 196 (45.3%) underwent initial subtotal colectomy followed by completion proctectomy with ileal pouch anal anastomosis. Anastomosis was stapled in 352 patients (81.3%) and hand-sewn in 81 (18.7%) patients. Mean follow-up was 108.5 ± 78.4 months. At the most recent follow-up, mean Cleveland Global Quality of Life score was 0.8 ± 0.2 and numbers of daytime and night-time bowel movements were 5.3 ± 3.1 and 1.6 ± 1.3, respectively. The majority of the patients (86.8%) were fully continent or only complained of rare incontinence. Most patients had no seepage (day, 84.3%; night, 72.4%) and did not wear any pads (day, 89.3%; night, 84.3%). Most denied dietary (71.3%), social (84.8%), work (85.7%), or sexual restrictions (87.6%) at the time of last follow-up. There were 92.7% of patients who said they would undergo ileal pouch anal anastomosis again and 95.2% would recommend surgery to others.


CONCLUSIONS
Restorative proctocolectomy with ileal pouch anal anastomosis can be performed in pediatric patients with acceptable morbidity and is associated with good long-term results in terms of gastrointestinal function, quality of life, and patient satisfaction.
Department of Colorectal Surgery, Digestive Disease Institute, Children's Hospital, Cleveland Clinic, Cleveland, OH.
Yavuz
Y
Ozdemir
Department of Colorectal Surgery, Digestive Disease Institute, Children's Hospital, Cleveland Clinic, Cleveland, OH.
Ravi P
RP
Kiran
Department of Colorectal Surgery, Digestive Disease Institute, Children's Hospital, Cleveland Clinic, Cleveland, OH.
Hasan H
HH
Erem
Department of Colorectal Surgery, Digestive Disease Institute, Children's Hospital, Cleveland Clinic, Cleveland, OH.
Erman
E
Aytac
Department of Colorectal Surgery, Digestive Disease Institute, Children's Hospital, Cleveland Clinic, Cleveland, OH.
Emre
E
Gorgun
Department of Pediatric Surgery, Children's Hospital, Cleveland Clinic, Cleveland, OH.
David
D
Magnuson
Department of Colorectal Surgery, Digestive Disease Institute, Children's Hospital, Cleveland Clinic, Cleveland, OH. Electronic address: remzif@ccf.org.
Feza H
FH
Remzi
D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome