title: Minimally Invasive Ileal Pouch-Anal Anastomosis with Rectal Eversion Allows for Equivalent Outcomes in Continence in Pediatric Patients.
abstract: BACKGROUND
  Different techniques for ileal pouch-anal anastomosis (IPAA) following total proctocolectomy (TPC) have been described in patients with ulcerative colitis (UC), including rectal eversion (RE). RE allows for precise identification of the dentate line, but concerns have been raised regarding continence rates. No studies have specifically evaluated RE in the pediatric population. The purpose of this study was to evaluate the outcomes and continence rates for pediatric patients undergoing minimally invasive surgery (MIS) TPC and IPAA with RE for UC.
  
  
  METHODS
  All patients who underwent TPC and IPAA were reviewed at our institution. Data collected included demographics, proctocolectomy technique (open without RE versus MIS with RE), operative time, postoperative data, and continence outcomes following ileostomy closure.
  
  
  RESULTS
  Thirty-three patients were identified who underwent TPC and IPAA between July 2006 and October 2014. Thirty of these patients underwent ileostomy takedown and were evaluated for continence. Of these, 17 (56.7%) patients had a laparoscopic procedure, 5 (16.7%) had a robotic-assisted procedure, and 8 (26.7%) had an open procedure. There were no statistically significant differences in regard to demographics, operative time, or length of stay when comparing the two groups. There were no differences in the two groups as measured at 1, 6, and 12 months in terms of number of daily stools (P = .93, .09, and .87, respectively), nighttime stooling (P = .29, .10, and .25, respectively), soiling (P = .43, .36, and .52, respectively), or stool-altering medication usage (P = .26, 1.00, and .37, respectively).
  
  
  CONCLUSIONS
  The RE technique can be used safely and effectively during MIS TPC and IPAA in children without altering continence rates.
authors.affiliation: 1 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio.|2 Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Huntington
authors.affiliation: 1 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Boomer
authors.affiliation: 1 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio.
authors.forename: Victoria K
authors.initials: VK
authors.lastname: Pepper
authors.affiliation: 1 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Diefenbach
authors.affiliation: 3 Department of Gastroenterology, Nationwide Children's Hospital , Columbus, Ohio.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dotson
authors.affiliation: 1 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio.
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000601:surgery; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome