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Pediatric chronic ulcerative colitis: does infliximab increase post-ileal pouch anal anastomosis complications?
Raelene Kennedy1, D Dean Potter, Christopher Moir
1Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Preoperative Infliximab (IFX) in pediatric patients undergoing ileal pouch anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) was associated with increased short-term complications. Long-term outcomes were similar between groups.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Immunomodulatory therapy
Background:
- Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is a standard treatment for chronic ulcerative colitis (CUC).
- Concerns exist regarding increased postoperative complications with preoperative Infliximab (IFX) use before IPAA.
- This study evaluates IFX's impact on pediatric IPAA outcomes.
Purpose of the Study:
- To compare postoperative complications in pediatric patients (≤ 18 years) undergoing IPAA for CUC.
- To assess the influence of preoperative Infliximab (IFX) treatment on short-term and long-term outcomes after IPAA.
Main Methods:
- Retrospective review of pediatric patients (≤ 18 years) who underwent IPAA for CUC between 2003 and 2008.
- Patients were divided into two groups: those who received preoperative IFX and those who did not.
- Complications within 1 year post-IPAA were analyzed, including leak, wound infection, small bowel obstruction, and pouchitis.
Main Results:
- Eleven patients received preoperative IFX, while 27 did not.
- The IFX group experienced a higher overall complication rate (55% vs. 26%) compared to controls.
- Small bowel obstruction was significantly more frequent in the IFX group (55% vs. 7%).
- Long-term complication rates were similar between the IFX and control groups (64% vs. 61%).
Conclusions:
- Pediatric patients treated with Infliximab (IFX) prior to IPAA had a twofold increase in postoperative complications.
- While short-term risks are elevated, long-term outcomes after IPAA appear comparable.
- Colectomy with end ileostomy is recommended for CUC patients receiving IFX within 8 weeks of colectomy.
Background:
Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is a common surgical approach to chronic ulcerative colitis (CUC). Preoperative use of Infliximab (IFX) has raised concern of increased postoperative complications. We sought to compare outcomes of pediatric patients (≤ 18 years) who were treated with IFX before IPAA to those who did not.
Methods:
Patients (≤ 18 years of age) who underwent IPAA from 2003 to 2008 for CUC were included, and their records were retrospectively reviewed for preoperative medications, operative technique, and 1-year postoperative complications (leak, wound infection, small bowel obstruction, pouchitis). Subjects were divided into 2 groups--those who received IFX preoperatively and those who did not.
Results:
Eleven patients received IFX preoperatively, and 27 children did not. All complications following IPAA were more frequent in the IFX group compared to controls (55% vs 26%). Small bowel obstruction was significantly higher in the IFX group (55% vs 7%). Long-term complications occurred in 64% of the IFX group and 61% of the controls.
Conclusion:
Children that were treated with IFX prior to IPAA suffered twice as many postoperative complications. Long-term outcomes are similar. Currently, we recommend colectomy with end ileostomy for patients that receive IFX within 8 weeks of colectomy for CUC.
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