Single-stage restorative proctocolectomy for ulcerative colitis in pediatric patients: a safe alternative

Area of Science:

• Pediatric surgery
• Gastroenterology
• Colorectal surgery

Background:

• Refractory ulcerative colitis (UC) in children often requires surgical intervention.
• Restorative proctocolectomy (RP) with ileal-pouch-anal-anastomosis (IPAA) is a common surgical approach.
• The safety and efficacy of single-stage versus multi-stage RP/IPAA remain unclear in pediatric populations.

Purpose of the Study:

• To compare the outcomes of single-stage versus two-stage RP/IPAA in pediatric patients with UC.
• To evaluate short-term and long-term results, including operative time, length of stay, complications, and functional outcomes.

Main Methods:

• Retrospective review of pediatric UC patients who underwent initial RP/IPAA between 2004 and 2019.
• Matching of 1-stage operations (n=33) with 2-stage operations (n=66) based on age, disease duration, and severity.
• Analysis of operative time, length of stay, readmission rates, pouch complications (leak, stricture), pouchitis, bowel movements, and incontinence.

Main Results:

• Single-stage RP/IPAA had significantly shorter median operative times (6h vs. 7h 47min) and total length of stay (9 days vs. 17 days).
• The single-stage group had lower readmission rates (9% vs. 30%) and stricture rates (16% vs. 50%).
• Pouch leak rates were similar, and functional outcomes (pouchitis, bowel movements, incontinence) showed no significant differences between the groups.

Conclusions:

• Both 1-stage and 2-stage RP/IPAA are viable options for pediatric UC patients, yielding comparable long-term and functional results.
• Single-stage RP/IPAA without ileostomy presents a safe and effective alternative to 2-stage procedures.
• These findings support the consideration of single-stage RP/IPAA for eligible pediatric UC patients.