Long-term Single-centre Outcomes After Proctocolectomy With Ileoanal Anastomosis for Paediatric Ulcerative Colitis

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Colorectal Surgery

Background:

• Childhood-onset ulcerative colitis (UC) frequently necessitates surgical intervention, with a significant proportion of patients requiring total colectomy.
• Proctocolectomy with ileoanal anastomosis (IAA) is a common surgical approach for managing pediatric UC.

Purpose of the Study:

• To evaluate the long-term surgical and functional outcomes of proctocolectomy with IAA in children diagnosed with UC.
• To identify risk factors associated with ileoanal anastomosis (IAA) failure and the need for permanent ileostomy.

Main Methods:

• Retrospective analysis of medical records for pediatric patients who underwent proctocolectomy with IAA for UC between 1985 and 2016.
• Data collected included disease history, surgical details, complications, functional outcomes, and postoperative diagnoses of Crohn's disease (CD).
• Cox regression analysis was employed to determine risk factors for IAA failure.

Main Results:

• Out of 87 patients, 98% had UC; 10% were diagnosed with postoperative Crohn's disease (CD) during a median follow-up of 7.8 years.
• Postoperative leakages (9%) and strictures (11%) were common, while fistulas (78%) and abscesses (56%) were more frequent in patients later diagnosed with CD.
• Nine percent of patients required conversion to a permanent ileostomy; risk factors included CD diagnosis, postoperative abscesses/fistulas, and three-stage surgery.

Conclusions:

• Proctocolectomy with IAA demonstrates reassuring long-term surgical and functional outcomes for pediatric UC patients.
• Postoperative CD diagnosis, fistulas, and abscesses are significant risk factors for ileostomy, highlighting the importance of careful patient selection and monitoring.
• While complications like leakages and strictures occur, they do not appear to be primary drivers of ileostomy in this cohort.