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Single-center review of staged restorative proctectomy for ulcerative colitis
Hannah L Rhodes1, Eleri Cusick2
1Department of Paediatric Surgery, Bristol Royal Hospital for Children, 24 Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom; Bristol Renal, Dorothy Hodgkin Building, University of Bristol, Bristol, BS1 3NY, United Kingdom.
Insights
Pediatric ulcerative colitis patients undergoing colectomy and J-pouch surgery experienced high complication rates, with two-thirds needing further operations. One in five developed Crohn's disease post-J-pouch, requiring careful pre-operative counseling.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting children.
- Surgical intervention, including total colectomy and restorative procedures like the J-pouch, is sometimes necessary for refractory UC.
- Outcomes and complication rates in pediatric UC patients undergoing these complex surgeries require thorough evaluation.
Purpose of the Study:
- To review the outcomes of pediatric patients who underwent total colectomy and restorative J-pouch surgery for ulcerative colitis.
- To identify the types and frequency of early and late complications following these procedures.
- To assess the long-term sequelae, including the development of Crohn's disease, after J-pouch surgery.
Main Methods:
- Retrospective analysis of consecutive pediatric patients undergoing colectomy for UC between 1995 and 2014.
- Data collection included surgical stages, length of stay, and postoperative complications.
- Complications were categorized as early (within 30 days) or late, with specific attention to pouch outcomes and development of Crohn's disease.
Main Results:
- Thirty-nine children underwent colectomy, with 21 J-pouch procedures (20 three-staged) performed.
- The most frequent complication across all surgical stages was bowel obstruction.
- Two-thirds of patients experienced complications requiring additional surgical interventions; one in five J-pouch patients developed Crohn's disease, with some developing it years after surgery.
Conclusions:
- Pediatric patients undergoing total colectomy and J-pouch surgery for UC face significant complication rates, necessitating multiple reoperations.
- The development of Crohn's disease after J-pouch surgery is a notable concern, occurring in a substantial proportion of patients.
- Comprehensive pre-operative counseling is crucial to inform patients and families about the risks and potential long-term implications of these surgical interventions.
Aim:
The purpose of this study was review results of pediatric patients undergoing total colectomy and restorative surgery for ulcerative colitis (UC) in a regional pediatric surgical center.
Methods:
A retrospective case note analysis of consecutive patients undergoing colectomy for UC between 1995 and 2014 was performed. Early complications were defined as occurring within 30 days of surgery. Data was expressed as median (range).
Results:
Of 39 children who had colectomy (59% female), 21 J-pouch procedures (20 three-staged) were undertaken at our center at median age 13 years (6-17 years). Length of stay (LOS) after colectomy was 8 days (6-21) with five early and eight late complications. LOS after J-pouch ileo-anal anastomosis was 7 days (5-19 days) with two early and three late complications. After ileostomy closure LOS was 6 days (4-16 days) with three early and two late complications. The most frequent complication following each surgical stage was bowel obstruction. There was only one pouch loss, which was secondary to development of Crohn's disease (CD), and three other patients with J-pouches also subsequently developed CD 1.5 to 10 years after their original colectomy but retained their pouch. Bowel frequency at 1-2 years post J-pouch in 14 patients was a median of 4 per 24 h (2-7 per 24 h).
Conclusion:
When all three postoperative stages were considered, two thirds of patients developed complications resulting in 15 additional visits to the operating theater. One in five patients subsequently developed CD after J-pouch. This should be carefully considered during pre-operative counseling.
Type Of Study:
Retrospective Study.
Level Of Evidence:
Level IV.
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