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Current surgical practice in pediatric ulcerative colitis: A systematic review
Sharman P Tan Tanny1, Minjung Yoo2, John M Hutson3
1Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; Surgical Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; The University of Edinburgh, The Royal College of Surgeons of Edinburgh, UK.
Insights
Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is a preferred surgical option for pediatric ulcerative colitis (UC). The number of surgical stages did not impact quality of life in children undergoing RPC-IPAA.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Inflammatory Bowel Disease
Background:
- Surgical management of adult ulcerative colitis (UC) is established, but pediatric applications differ.
- Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is the preferred surgical approach for pediatric UC patients with adequate anal sphincter function.
- RPC-IPAA can be performed as a one-, two-, or three-stage procedure.
Purpose of the Study:
- To systematically review the existing literature on restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) in pediatric ulcerative colitis (UC).
- To analyze the outcomes and complications associated with different surgical approaches for pediatric UC.
Main Methods:
- A systematic review of controlled trials was conducted using Cochrane Register, PubMed, and EMBASE databases.
- Data were collected from January 1987 to December 2016, adhering to PRISMA guidelines.
- Twelve retrospective studies involving 568 pediatric patients were identified and analyzed.
Main Results:
- Patients underwent one-stage (31), two-stage (334), or three-stage (203) RPC-IPAA procedures.
- Common postoperative complications included pouchitis, bowel obstruction, stricture, fistula, pouch failure, anastomotic leak, and wound infections.
- Calcineurin inhibitor use improved the Pediatric Ulcerative Colitis Activity Index (PUCAI) score, and higher PUCAI scores correlated with staged procedures. The number of stages did not affect quality of life.
Conclusions:
- Limited data exist regarding preoperative factors influencing the decision for staged procedures in pediatric UC.
- Further research is needed to identify predictive factors for staged RPC-IPAA in pediatric ulcerative colitis.
- The number of surgical stages does not appear to compromise the quality of life for pediatric patients undergoing RPC-IPAA.
Background:
Surgical management of adult ulcerative colitis (UC) is well-studied, but not readily applicable to children. Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA), performed as one-, two-, or three-stage procedure, is preferred in pediatric patients with adequate anal sphincter function.
Purpose:
METHODS: Systematic review of Cochrane Register of Controlled Trials, PubMed, and EMBASE databases was conducted (January 1987-December 2016), in accordance with PRISMA.
Results:
Twelve retrospective studies were identified (568 patients total); 31, 334, and 203 patients underwent one-, two-, and three-stage procedures, respectively. Median study size was 31 patients (range 10-202), median age was 13 years (range 2-21), median follow-up was 4 years (range 0.08-16). Postoperative complications included pouchitis, bowel obstruction, stricture, fistula, pouch failure, anastomotic leak, and wound infections. Calcineurin inhibitor usage improved pediatric ulcerative colitis activity index (PUCAI) score. Higher PUCAI scores correlated with likelihood of staged procedures. Number of stages did not restrict quality of life.
Conclusions:
Paucity of data exists, comparing preoperative factors leading to staged procedures in pediatric UC. This systematic review identifies an area for future studies.
Level Of Evidence:
II.
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