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Single-stage laparoscopic proctocolectomy with ileal pouch-anal anastomosis for familial adenomatous polyposis
Andrew Mudreac1,2, Spencer E Kim3, Kara Kennedy1,4
1General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Insights
Single-stage laparoscopic proctocolectomy with ileal pouch-anal anastomosis (LPC-IPAA) is a safe procedure for children with familial adenomatous polyposis (FAP). This approach offers favorable functional outcomes, making it a viable surgical option for young patients.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Oncology
Background:
- Familial adenomatous polyposis (FAP) is a genetic disorder predisposing individuals to colorectal cancer.
- Surgical intervention is often necessary to manage FAP, with proctocolectomy being a common procedure.
- Minimally invasive techniques like laparoscopic surgery are increasingly explored for pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of single-stage laparoscopic proctocolectomy with ileal pouch-anal anastomosis (LPC-IPAA) in pediatric patients diagnosed with FAP.
- To assess postoperative complications and functional outcomes following LPC-IPAA in this specific patient population.
Main Methods:
- Retrospective review of medical records for FAP patients who underwent LPC-IPAA between January 2013 and August 2024 at a dedicated pediatric center.
- Analysis of baseline characteristics, operative details (stapled vs. hand-sewn anastomosis), postoperative complications (anastomotic leaks, abscesses, pouchitis, strictures), and functional outcomes (fecal incontinence).
Main Results:
- Thirty-nine pediatric FAP patients underwent LPC-IPAA, with a mean age of 14.9 years.
- No anastomotic leaks were observed. One postoperative abscess and 15% rates of pouchitis and anastomotic strictures were reported, with successful management.
- No patients required treatment for fecal incontinence, indicating favorable functional outcomes.
Conclusions:
- Single-stage LPC-IPAA is a safe and effective surgical option for adolescents and young adults with FAP.
- The procedure is associated with a low complication rate and positive functional outcomes, supporting its use in pediatric FAP management.
Purpose:
Assess the safety of single-stage laparoscopic proctocolectomy with ileal pouch-anal anastomosis (LPC-IPAA) in children with familial adenomatous polyposis (FAP).
Methods:
Medical records for all patients with FAP who underwent LPC-IPAA between 1/1/2013 and 8/1/2024 at a pediatric center were reviewed. Baseline characteristics, postoperative complications, and functional outcomes were assessed.
Results:
Thirty-nine patients met inclusion criteria. Mean age was 14.9 years (range 9.4-21.5) and mean BMI was 23.0 (range 15.3-47.0). Follow-up averaged 2.8 years (SD 2.9). Mean operative time was 228.4 min (SD 44.5) in the stapled group (n = 32) and 316.1 min (SD 43.1) in the hand-sewn group (n = 7) (p < 0.001). There were no anastomotic leaks. One patient developed a postoperative abscess. Six (15%) developed presumed pouchitis, 4 of whom were in the hand-sewn group and all successfully treated with antibiotics. Six patients (15%) developed an anastomotic stricture - all in the stapled group - and responded well to anal dilation. No patient required treatment for fecal incontinence.
Conclusion:
LPC-IPAA in adolescents and young adults with FAP can safely be performed in a single operation and is associated with favorable functional outcomes.
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