title: Long-term outcomes and sex differences after restorative proctocolectomy in pediatric patients with ulcerative colitis.
abstract: BACKGROUND
  Restorative proctocolectomy (RPC) for ulcerative colitis (UC) could result in a higher patient quality of life, avoiding frequent disease flares; however, pouch failures and pouch-related complications (PRCs) can develop.
  
  
  OBJECTIVE
  No cohort studies have examined pouch failure and the differences between adult and pediatric patients or the sex differences in pediatric UC. Therefore, the pouch failure rates were compared between adults and pediatric patients, and pouch failure and PRCs in pediatric UC were evaluated.
  
  
  METHODS
  UC patients who underwent RPC between January 1987 and June 2014 at Hyogo College of Medicine were included. Patient background characteristics, PRCs, and pouch failure were reviewed.
  
  
  RESULTS
  A total of 1347 adult UC patients and 90 (51 boys, 39 girls) pediatric UC patients were included in the study. The cumulative rate of pouch failure at 10years after RPC was significantly higher in pediatric UC (9.5%) than in adult UC (2.1%; p<0.01). In pediatric UC, the independent risk factors for pouch failure were pouchitis (hazard ratio (HR) 19.3) and anal fistula (HR 5.5). Although a sex difference was not seen in pouch failure, an independent risk factor for PRCs was being a girl (HR 2.5).
  
  
  CONCLUSIONS
  Pouch failure was more common in pediatric than in adult UC. PRCs after RPC were more common in girls in pediatric UC.
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirata
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. Electronic address: motoi.uchino@nifty.ne.jp.
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Bando
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Hirose
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Teruhiro
authors.initials: T
authors.lastname: Chohno
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Horio
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Nobuyui
authors.initials: N
authors.lastname: Hida
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hori
authors.affiliation: Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.affiliation: Division of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Division of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
authors.affiliation: Department of inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D017211:Treatment Failure
keywords: Pediatric; Pouch failure; Pouch-related complication; Restorative proctocolectomy; Ulcerative colitis