title: Histologic inflammatory activity of the rectal margin as a predictor of postoperative complication in ileoanal anastomosis (J-pouch) procedure in children with refractory ulcerative colitis.
abstract: BACKGROUND
  Postoperative complication from the ileoanal anastomosis (J-pouch) procedure for surgical management of refractory ulcerative colitis (UC) increases the risk of pouch dysfunction. The purpose of this study was to determine if histologic inflammatory activity of the rectal margin is an independent predictor of complication after controlling for other variables.
  
  
  METHODS
  A retrospective chart review was performed to identify all pediatric patients with UC who underwent a J-pouch procedure between 1995 and 2014. Univariate and multivariate regression analyses were performed on the following variables: age at surgery, body mass index, comorbidities, time between colectomy and pouch, mucosectomy, protective ileostomy status, length of pouch, and histologic inflammatory activity in the intestinal epithelium of the rectal margin.
  
  
  RESULTS
  Nineteen complicated and 23 uncomplicated cases were included. Histologic inflammatory activity was significantly higher among the complicated group (9.3±3.1 vs. 4.1±3.1, p=0.02). No significant difference was found regarding other variables. In a multivariate regression, histologic inflammation of the rectal margin remained significantly associated with complication (p=0.04) after adjusting for other factors.
  
  
  CONCLUSIONS
  After controlling for potential confounders, histologic inflammatory activity at the rectal margin was found to be a significant predictor of postoperative complication in the J-pouch procedure for refractory UC.
  
  
  METHODS
  2b.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Nada
authors.initials: N
authors.lastname: Gawad
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Dina
authors.initials: D
authors.lastname: El Demellawy
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wayne
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Juan
authors.initials: J
authors.lastname: Bass
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: anasr@cheo.on.ca.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
mesh_terms: D000293:Adolescent; D002648:Child; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology* / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D012007:Rectum / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Complication; Ileoanal histology; Pediatric; Surgery; Ulcerative colitis