C. C. Huang1, F. J. Rescorla1, M. P. Landman1 1Indiana University School Of Medicine,Department Of Pediatric Surgery,Indianapolis, IN, USA
Introduction:
Ileal pouch-anal anastomosis (IPAA) is the standard surgical reconstruction for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) who undergo total proctocolectomy (TPC). Although FAP and UC patients receive the same reconstruction, their postoperative complications can differ in type and severity. We hypothesize that indication for total proctocolectomy and other preoperative clinical factors are associated with differences in postoperative outcomes following IPAA.
Methods:
A retrospective cohort of pediatric patients who underwent proctocolectomy with IPAA at Riley Hospital for Children from 1996-2016 was identified. Relevant preoperative, operative, and postoperative clinical variables were collected. Univariate analyses were performed to evaluate for relevant clinical differences in outcome. The sample size limited the ability to perform multivariate analyses.
Results:
A total of 79 patients, 17 with FAP and 62 with UC, were identified. Preoperatively, as expected, UC patients had more frequent abdominal pain (p<0.001), more hospitalizations (p=0.004), and lower albumin (p<0.001) than FAP patients. FAP patients spent an average of 1125±1011 days between initial diagnosis and first surgery compared to 585±706 days by UC patients (p=0.038). FAP patients took an average of 57±38 days to complete TPC with IPAA compared to UC patients at 177±121 days (p=<0.001). At their first postoperative visit, FAP and UC patients did not differ in average number of bowel movements [4.3±2.3 vs. 6.1±3.9, respectively (p=0.083)]. In addition, FAP and UC patients also did not differ in average number of bowel movements at their 6 month postoperative visit [4.7±2.1 vs. 5.6±1.9, respectively (p=0.134)]. Postoperatively, FAP patients are significantly less likely to experience pouchitis (p=0.013), pouch failure (p=<0.001), psychiatric symptoms (p=0.017), and daily antimotility agent use (p=0.003) but more likely to experience bowel obstruction (p=0.001). Within the UC group, preoperative steroid use was associated with superficial surgical infection (p=0.049) but not associated with pouchitis (p=0.872).
Conclusion:
IPAA is a safe, restorative treatment for FAP and UC patients after TPC. Based on diagnosis and preoperative clinical course, there are differences in morbidity in IPAA patients. This data is limited by sample size and inability to perform multivariable analyses. Clinical data such as these will allow surgeons to help families anticipate their child’s pre- and post-operative course and to maximize successful clinical outcomes.