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Stapled restorative proctocolectomy in children with refractory ulcerative colitis
Girolamo Mattioli1, Marco Castagnetti, Paolo Gandullia
1Department of Paediatric Surgery, G. Gaslini Research Institute, University of Genoa, 16147-Genoa, Italy.
Insights
Stapled ileoanal anastomosis in children with ulcerative colitis shows low complications but high rates of persistent cuff inflammation. This condition is usually asymptomatic but may impact nighttime continence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the colon.
- Refractory UC in children often necessitates surgical intervention, including colectomy and ileoanal anastomosis.
- Restorative proctocolectomy with stapled anastomosis is a surgical option for managing pediatric UC.
Purpose of the Study:
- To evaluate the outcomes of stapled restorative proctocolectomy in children with refractory ulcerative pancolitis.
- To assess the incidence of complications, anastomotic function, and long-term results.
- To investigate the prevalence and impact of cuffitis and ileal inflammation.
Main Methods:
- Retrospective review of 16 children with refractory ulcerative pancolitis who underwent stapled straight ileoanal anastomosis.
- Clinical examinations and endoscopic assessments with biopsies of the terminal ileum and columnar cuff during follow-up.
- Median follow-up of 5.3 years after bowel restoration.
Main Results:
- Low major complication rate (12.5%), with no cases of dysplasia or cancer.
- All anastomoses were functional; however, 94% of children had persistent cuff inflammation (cuffitis), mostly asymptomatic.
- Continence was achieved in 87.5% for daytime and 62.5% for nighttime; severe cuffitis correlated with nighttime incontinence.
Conclusions:
- Stapled ileoanal anastomosis in pediatric ulcerative pancolitis is associated with low morbidity.
- Persistent cuffitis is common but generally asymptomatic, though it can be linked to nighttime incontinence.
- This surgical approach offers functional restoration with manageable long-term inflammatory changes.
Objective:
The aim of this study was to review the results after stapled restorative proctocolectomy among children with refractory ulcerative colitis.
Patients And Methods:
Clinical records of 16 consecutive children with refractory ulcerative pancolitis undergoing colectomy and stapled straight ileoanal anastomosis at a median age of 8.3 years (range, 3.1-14.9 years) were reviewed. Periodical clinical examinations and endoscopies with biopsies above (terminal ileum) and below (columnar cuff) the anastomosis were carried out during follow-up. Median follow-up after bowel restoration lasted 5.3 years (range, 1.2-9.6 years).
Results:
Two major complications occurred (12.5%), 1 episode of sepsis treated conservatively and 1 bowel perforation proximal to the anastomosis treated with a temporary diverting ileostomy. All the anastomoses were functional at the end of the study. The columnar cuff averaged 2.6 cm in length and presented signs of persistent inflammation (cuffitis) in 94% of children. Inflammation responded poorly to any medical treatment but was symptomatic in 1 case only. Ileal inflammation was detected endoscopically in 31% of patients and histologically in 62.5%. No case of dysplasia or cancer was recorded. At final follow-up, children had an average of 7.1 +/- 3.1 bowel movements per day; full daytime and nighttime continence were achieved in 87.5% and 62.5% of cases, respectively. A severe inflammation of the columnar cuff was associated with an increased risk of nighttime incontinence.
Conclusions:
Stapled ileoanal anastomosis in children with pancolitis is associated with low morbidity. Refractory cuffitis persists in almost all patients but is mostly asymptomatic, although it could be associated with nighttime incontinence.
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