Related Experiment Video
Updated: Feb 3, 2026
Chinese Herbal Retention Enema for the Treatment of Ulcerative Colitis
Published on: May 16, 2025
Long-term Single-centre Outcomes After Proctocolectomy With Ileoanal Anastomosis for Paediatric Ulcerative Colitis
Iiris Nyholm1, Maria Hukkinen1, Antti Koivusalo1
1Section of Paediatric Surgery, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
Insights
Proctocolectomy with ileoanal anastomosis (IAA) offers reassuring long-term outcomes for children with ulcerative colitis (UC). Postoperative Crohn's disease diagnosis, fistulas, and abscesses increase the risk of ileostomy, but overall functional results are positive.
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.
Background And Aims:
Childhood-onset ulcerative colitis [UC] requires total colectomy in one-quarter of patients at some point of their disease. The study objective was to evaluate long-term outcomes after proctocolectomy with ileoanal anastomosis [IAA] for paediatric UC.
Methods:
Medical records of all children undergoing proctocolectomy with IAA for UC during 1985-2016 in Helsinki University Hospital were retrospectively assessed. Data on disease history, diagnostic and operative details, occurrence of surgical complications, functional outcome, postoperative diagnosis of Crohn's disease [CD] and pouch failure were collected. Risk factors for IAA failure were analysed with Cox regression.
Results:
Of 87 patients, 85 [98%] had UC and 2 [2%] inflammatory bowel disease unclassified [IBD-U] preoperatively. Altogether 66% underwent two-stage and 34% underwent three-stage procedures. During 7.8 [4.1-14.5] years' follow-up, nine [10%] patients were diagnosed with postoperative CD. Postoperative leakages [n = 8, 9%] and strictures [n = 10, 11%] were equally common, whereas fistulas [78% vs 9%, p <0.001] and abscesses [56% vs 14%, p = 0.009] were more frequent among patients with later CD diagnosis. At latest follow-up, eight [9%] patients had been converted to a permanent ileostomy and others reported daytime stooling frequency of 5 [4-7] and 0.5 [0-1] at night. CD diagnosis (hazard ratio [HR] = 23.3, p = 0.005), postoperative abscesses [HR = 16.3, p = 0.013] and fistulas [HR = 20.9, p = 0.007] as well as three-stage surgery [p = 0.018] increased risk for ileostomy.
Conclusions:
For paediatric UC, long-term surgical and functional outcomes after proctocolectomy with IAA are reassuring. Need for three-stage surgery and occurrence of postoperative fistulas and abscesses, but not leakages or strictures, associate with postoperative CD diagnosis and the risk for ileostomy.
Related Concept Videos
01:29Drugs for Treatment of Ulcerative Colitis in IBD
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
02:24Predicting Reaction Outcomes
01:13Outcomes of Glycolysis
Cellular respiration can occur aerobically (with oxygen) or anaerobically (without oxygen). In the presence of oxygen, cellular respiration starts with glycolysis and continues with pyruvate...
01:05Long-term Depression
01:28Peptic Ulcer Disease II: Pathophysiology
Damaging agents such as Helicobacter pylori, gastric acid, pepsin, and nonsteroidal anti-inflammatory drugs (NSAIDs) can weaken the mucosal defense, allowing hydrogen ions to infiltrate back and harm epithelial cells.