title: Value of histopathology for predicting the post-operative complications of ileo-anal anastomosis (J-pouch) procedure in children with refractory ulcerative colitis.
abstract: The J-pouch is a surgical procedure offered to children with refractory ulcerative colitis (UC) who have undergone subtotal colectomy to reconstruct a reservoir function with ileo-anal anastomosis. Unfortunately, post-operative complications may occur and can compromise the pouch function. We assessed rectal histopathology to determine whether severity of inflammation in the rectum prior to the creation of the J-Pouch was associated with post-operative complications. We retrospectively reviewed the histopathology of all J-pouch procedure specimens from paediatric patients during the period 2000-2013 using an objective grading system that assesses the chronicity and activity of the UC disease. We analysed the parameters for association with the post-operative complications. A classification tree algorithm was generated to predict the risk of complication based on histopathological parameters. A total of 28 paediatric patients were identified, among whom 10 developed post-operative complications (35%). The activity score at the recto-anal margin was higher among the patients with post-operative complications (mean 7.3±3.1 versus 4.8±3.1; p=0.04). The involvement of more than 5% colonic crypts with epithelial neutrophilic infiltration at the recto-anal margin was found to be an independent parameter that would stratify the patients into low-risk or high-risk group for developing complications (17% versus 64%; p=0.04). An association between UC disease activity at the recto-anal margin and post-operative J-pouch complications was determined. Potentially, this association suggests that a histopathological assessment of the recto-anal transitional zone may have value in guiding the surgeon on the risk of post-operative complications.
authors.affiliation: Department of Pediatric Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. Electronic address: deldemellawy@cheo.on.ca.
authors.forename: Dina
authors.initials: D
authors.lastname: El Demellawy
authors.affiliation: University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Soufiane
authors.initials: S
authors.lastname: El Hallani
authors.affiliation: Department of Pediatric Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: de Nanassy
authors.affiliation: University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: James Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Chan
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Katrina
authors.initials: K
authors.lastname: Sullivan
authors.affiliation: University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Juan
authors.initials: J
authors.lastname: Bass
authors.affiliation: University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.affiliation: University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002648:Child; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000473:pathology; D012189:Retrospective Studies; D012737:Sex Factors
keywords: Ulcerative; activity; colitis; complication; pouch