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Outcomes in pediatric patients undergoing straight vs J pouch ileoanal anastomosis: a multicenter analysis
Rupa Seetharamaiah1, Brady T West, Sarah J Ignash
1Section of Pediatric Surgery, C S Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI 48109, USA.
Insights
Outcomes for straight (SIAA) vs J pouch (JPAA) ileoanal anastomosis in children show SIAA has higher stool frequency and JPAA has increased pouchitis. However, functional stooling scores and continence rates improve over time and are excellent for both techniques.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Colorectal surgery
Background:
- Outcomes of straight ileoanal anastomosis (SIAA) versus J pouch ileoanal anastomosis (JPAA) in children remain controversial.
- Limited data exists for pediatric patients undergoing these procedures.
- This study compares outcomes from three centers with extensive experience in both SIAA and JPAA.
Purpose of the Study:
- To compare the functional outcomes and complication rates of SIAA and JPAA in pediatric patients.
- To evaluate the long-term results of these surgical techniques in children undergoing proctocolectomy.
Main Methods:
- Retrospective analysis of 250 children undergoing proctocolectomy with either SIAA or JPAA.
- Functional stooling scores were developed to assess outcomes over the first three years post-surgery.
- Data analyzed using chi-squared tests and generalized linear mixed models.
Main Results:
- SIAA patients had significantly higher daytime and nighttime stooling frequencies initially, but frequencies converged over time.
- JPAA patients experienced significantly higher rates of symptomatic pouchitis compared to enteritis after SIAA.
- No significant difference in surgical complication incidence; continence rates were excellent in both groups.
Conclusions:
- Both SIAA and JPAA are associated with morbidity, with SIAA leading to higher stool frequency and JPAA to increased pouchitis.
- Functional outcomes and stooling scores improve over time and become similar between the two techniques.
- Continence rates are excellent regardless of the surgical technique, though JPAA may offer slightly better continence.
Background:
Outcomes remain controversial for patients undergoing straight (SIAA) vs J pouch (JPAA) ileoanal anastomosis, particularly in children where fewer such cases are performed. Our 3 centers have had extensive experience with both techniques. Thus, we had the unique opportunity to compare outcomes within the same centers.
Methods:
We retrospectively analyzed 250 children after proctocolectomy with either SIAA or JPAA, for the first 3 years after pull-through. A functional stooling score was developed to further assess outcomes. Data were analyzed using chi(2) tests and generalized linear mixed models for repeated measures.
Results:
Two hundred three patients had sufficient data for complete analysis (42% males; mean surgery age, 15 +/- 7years). Surgical indications were ulcerative colitis (168) and familial adenomatoid polyposis (35). Surgical procedures included SIAA (112) and JPAA (91). Daytime and nighttime stooling frequencies were significantly higher (P < .013) for SIAA patients at 1 to 24 months after pull-through; however, stooling frequencies began approximating each other by this time. Symptomatic pouchitis (compared to enteritis after SIAA) was significantly higher in JPAA patients (odds ratio, 4.5; confidence interval, 2.32-8.72). Frequency of pouchitis declined with time. There was no significant difference in the incidence of surgical complications between the 2 groups. Finally, continence rates were strikingly good in both groups compared to previously reported series.
Conclusion:
Straight ileoanal anastomosis and JPAA are associated with considerable morbidity; SIAA has higher stool frequency and JPAA has increased pouchitis. Over time, we found that problems improved, and functional stooling scores became similar. JPAA had consistently lower stool frequency and better continence rates; however, these differences were small and may have minimal clinical significance. In addition, such differences need to be balanced against the high rate of pouchitis with JPAA. Continence was excellent regardless of the technique.
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