title: Long-term follow up of ileal pouch anal anastomosis in a large cohort of pediatric and young adult patients with ulcerative colitis.
abstract: OBJECTIVE
  The study's aim is to determine long-term outcomes in a large cohort of pediatric and young adult patients who underwent proctocolectomy with ileal pouch anal anastomsis (IPAA) for ulcerative colitis (UC).
  
  
  METHODS
  Patients diagnosed with UC in childhood or adolescence (age≤21years) who underwent IPAA in childhood, adolescence, or young adulthood between 1982 and 1997 were contacted to determine pouch history, complications, and quality of life.
  
  
  RESULTS
  Data were obtained from 74 patients out of a previously reported cohort. Median age at diagnosis of UC was 15years and at surgery was 18years. Median follow-up was 20years. Complications during follow-up were pouchitis (45%), strictures (16%), fistulae (30%), obstruction (20%), and change of diagnosis to Crohn's (28%). Twenty-three percent reported no complications. Fourteen percent had pouch failure, with Crohn's and fistulae reported to be the most frequent complications. Seventy-nine percent reported being very satisfied at 20years follow-up.
  
  
  CONCLUSIONS
  To our knowledge, this study represents the largest cohort with the longest follow-up of pediatric and young adult patients undergoing IPAA for UC. Change in diagnosis to Crohn's and development of fistulae are risk factors for pouch failure. Despite reported complications, IPAA remains an excellent option for pediatric patients with UC.
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH.
authors.forename: Angela
authors.initials: A
authors.lastname: Shannon
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH.
authors.forename: Katharine
authors.initials: K
authors.lastname: Eng
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH.
authors.forename: Marsha
authors.initials: M
authors.lastname: Kay
authors.affiliation: University of Maryland Children's Hospital, Baltimore, MD.
authors.forename: Samra
authors.initials: S
authors.lastname: Blanchard
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH.
authors.forename: Robert
authors.initials: R
authors.lastname: Wyllie
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH.
authors.forename: Lori
authors.initials: L
authors.lastname: Mahajan
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Ian
authors.initials: I
authors.lastname: Lavery
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Victor
authors.initials: V
authors.lastname: Fazio
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Crohn's disease; Ileal pouch anal anastomosis; Long-term outcomes; Pediatrics; Pouch failure; Ulcerative colitis