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Transabdominal re-do pouch surgery in pediatric patients for failed ileal pouch anal anastomosis: a case matched
Erman Aytac1,2, Eren Esen1,3, H Hande Aydinli3,2
1Department of General Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
Insights
Re-do ileal pouch anal anastomosis (IPAA) is a safe and feasible procedure for children with failed IPAA. Outcomes in pediatric patients are comparable to adults, demonstrating similar short- and long-term results in experienced surgical centers.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
- Surgical outcomes
Background:
- Limited data exists on the safety and feasibility of re-do ileal pouch anal anastomosis (IPAA) in pediatric patients with failed pouches.
- Re-do IPAA is a complex procedure with potential for complications.
Purpose of the Study:
- To compare the short- and long-term outcomes of re-do IPAA in pediatric and adult populations.
- To assess the safety and feasibility of re-do IPAA in children.
Main Methods:
- A case-matched study comparing pediatric and adult patients undergoing transabdominal re-do IPAA.
- Review of short- and long-term outcomes including complications, functional outcomes, and quality of life.
- Data collected between March 2007 and June 2017 by a single surgeon.
Main Results:
- 30 pediatric and 30 adult patients were included in the study.
- The time between the initial IPAA and re-do IPAA was significantly shorter in the pediatric group.
- Trends suggested fewer postoperative complications in the pediatric group, with comparable long-term pouch survival between groups.
Conclusions:
- Re-do IPAA is a safe and feasible surgical option for pediatric patients experiencing IPAA failure.
- Short- and long-term outcomes for re-do IPAA in children are similar to those in adult patients.
- Performing re-do IPAA in experienced hands leads to comparable results in pediatric and adult populations.
Purpose:
Data regarding safety and feasibility of re-do ileal pouch anal anastomosis (IPAA) for failed ileal pouch in children are limited. In this study, we compared the short- and long-term outcomes of re-do IPAA in pediatric and adult populations in a case-matched setting.
Methods:
Between March 2007 and June 2017, pediatric patients undergoing a transabdominal re-do IPAA by single surgeon were reviewed and case matched with adult counterparts. Short- and long-term outcomes including complications, functional outcomes, and quality of life of the two groups were compared.
Results:
60 patients were included (pediatric, n = 30; adult, n = 30). Time between index IPAA and re-do IPAA was shorter in the pediatric group (30 ± 26 vs 86 ± 74 months, p = 0.001). In the pediatric population, the existing pouch was more commonly used to construct the re-do pouch (n = 19 vs n = 12, p = 0.07). There was a trend towards the presence of less postoperative complications in pediatric group (n = 13 vs n = 20, p = 0.07). There were no reoperations or mortality. Long-term pouch survival was comparable between two groups (p = 0.96). Six re-do IPAAs failed in the study period.
Conclusion:
Re-do IPAA is safe and feasible in pediatric population with failed IPAA and can be performed with similar short- and long-term outcomes compared to adults in experienced hands.
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