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Colectomy in pediatric ulcerative colitis: A single center experience of indications, outcomes, and complications
James J Ashton1, Hendt P Versteegh2, Akshay Batra1
1Department of Paediatric Gastroenterology, Southampton Children's Hospital, Tremona Road, Southampton, SO16 6YD, UK.
Insights
Approximately 9% of pediatric ulcerative colitis (UC) patients required colectomy, with half experiencing early complications and one-third needing reoperation. Late complications also affected one-third of these young patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease
Background:
- Limited data exists on colectomy outcomes for pediatric ulcerative colitis (UC).
- This study details the 18-year experience of a regional center.
Purpose of the Study:
- To report outcomes and complications of colectomy in children with UC.
- To analyze the incidence of early and late complications and reoperation rates.
Main Methods:
- Retrospective review of a prospective database for patients diagnosed with UC before age 17.
- Calculation of pre- and post-operative height/weight-SDS.
- Data analysis of complications and reoperation rates.
Main Results:
- 19 out of 220 (9%) pediatric UC patients underwent colectomy, all after failing maximal medical therapy.
- 47% experienced early complications requiring reoperation in 37% of cases.
- 32% developed late complications, with 5 needing laparotomy.
Conclusions:
- Colectomy is required in approximately 1 in 11 children with UC during their disease course.
- Half of the patients undergoing colectomy faced acute complications, with a significant need for reoperation.
- Late complications are also a considerable concern, affecting one-third of patients.
Background/Purpose:
There is a paucity of data on outcomes and complications of colectomy for pediatric ulcerative colitis (UC). This study reports the experience of a regional center for 18years.
Methods:
Patients were identified from a prospective database and data obtained by note review. Median height/weight-SDS were calculated preoperatively and postoperatively. Data are expressed as median values (range).
Results:
220 patients with UC (diagnosed <17years) were identified, and 19 (9%) had undergone colectomy. Age at diagnosis was 11.6years (1.3-16.5), and 42% of patients were male. Time from diagnosis to surgery was 2.2years (0.1-13.1). All patients had failed maximal medical therapy. Fifteen patients had urgent scheduled operation, and 4 had emergency procedures, with 2 for (11%) acute-severe colitis (1 Clostridium difficile colitis) and 2 for acute-severe colitis with toxic dilatation. All initial procedures were subtotal-colectomy with ileostomy. Nine patients (47%) had early complications (during initial admission), 7 (37%) requiring reoperation. Six (32%) had late complications, with 5 requiring laparotomy. No patients had both early and late complications. Height-SDS was -0.27 before surgery and -0.23 (maximal follow-up). Weight-SDS was 0.32 and 0.05 (maximal follow-up).
Conclusion:
Approximately 1/11 children with UC required colectomy during childhood. Half of patients had acute complications, and 1/3 of patients required another operation during their first admission. 1/3 of patients developed late complications.
