title: Ileal pouch anal anastomosis in pediatric familial adenomatous polyposis: a 24-year review of operative technique and patient outcomes.
abstract: BACKGROUND
  Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is the operative procedure of choice for familial adenomatous polyposis (FAP) patients. We review 24years of operative experience and outcomes in pediatric patients with FAP.
  
  
  METHODS
  Patients with FAP, age<20years, presenting to a single institution between 1987 and 2011 were included. Operative technique and outcomes were reviewed retrospectively. Primary outcomes included postoperative complications (30days), long-term bowel function, and polyp recurrence at the anal anastomosis.
  
  
  RESULTS
  95 patients with FAP underwent IPAA. Mean age at IPAA was 15.5years with a mean follow-up of 7.6years. 29 patients underwent 1-stage IPAA, 65 patients had a two-stage IPAA, and 1 patient underwent a 3-stage procedure. 67 patients had an open procedure, 25 underwent a laparoscopic approach, and more recently 3 patients underwent single incision laparoscopic IPAA. Patients with 1-stage IPAA demonstrate better long term bowel control vs. 2-stage IPAA patients (10.7% vs. 36.0% occasional incontinence, p=0.018). However, 1-stage IPAA patients suffered increased short-term complications, such as anastomotic leak (17.2% vs. 0%, p=0.002) and reoperation (20.7% vs. 4.6%, p=0.02) compared to 2-stage IPAA. Anal anastomosis polyp recurrence occurred in 22.7% of 1-stage patients and 10.0% of 2-stage patients. Short-term complications, polyp recurrence, or long-term continence were equivalent between open and laparoscopic cases.
  
  
  CONCLUSIONS
  Single-stage IPAA in children with FAP is associated with better bowel control but increased anastomotic leak, reoperative rate, and polyp recurrence. In experienced hands, laparoscopic IPAA is equivocal to open IPAA.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: kennedy.raelene@mayo.edu.
authors.forename: Raelene D
authors.initials: RD
authors.lastname: Kennedy
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Moir
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Shennen A
authors.initials: SA
authors.lastname: Mao
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Pediatrics, Mayo Clinic, Rochester, MN.
authors.forename: Mounif
authors.initials: M
authors.lastname: El-Youssef
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Iowa, Iowa City, IA.
authors.forename: D Dean
authors.initials: DD
authors.lastname: Potter
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery; D039021:Colonic Pouches; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Familial adenomatous polyposis; Ileal pouch anal anastomosis; Pediatric