N. Bismar1, A. S. Patel1,2, D. Schindel1,2 2Children’s Medical Center,Pediatric Surgery,Dallas, Tx, USA 1University Of Texas Southwestern Medical Center,Pediatric Surgery,Dallas, TX, USA
Introduction:
To compare the outcomes of pediatric medically-refractory ulcerative colitis treated by a traditional (TIPAA) surgical approach (1st stage: laparoscopic proctocolectomy/ileo pouch-anal anastomosis with a protective loop ileostomy; 2nd stage: stoma closure) versus a nontraditional (NIPAA) approach (1st stage: laparoscopic colectomy/ileostomy; 2nd stage: completion proctectomy/ileo-pouch anal anastomosis without a stoma).
Methods:
After IRB approval, a review of patients who underwent an ileo-pouch anal anastomosis, cared for at a children’s hospital from 2002-2017 was performed. Patient demographics, diagnosis at time of surgery, type of surgery (TIPAA vs NIPAA), time to full diet, level of continence, use of anti-diarrhea medications, and complications were recorded. A statistical analysis was performed using Graphpad® San Diego, CA.
Results:
Forty-one children were identified (NIPAA; n=14; TIPAA; n=27). Following re-establishing bowel continuity, there were no significant differences in time to appetite recovery, continence, or incidence of complications between the TIPAA and NIPAA groups. The number of anti-diarrhea medications prescribed was significantly higher in the group following a TIPAA versus the NIPAA (p=0.01). Nine patients (22%) required dilatation of an ileoanal anastomotic stricture, three following NIPAA and six following TIPAA (p=NS). In addition to strictures, the most common complications observed were pouchitis and small bowel obstruction. Thirteen patients (31.7%) were treated for pouchitis: four following a NIPAA and nine in the TIPAA group (p=NS). Of the 41 patients there were 11 who required additional surgical interventions (lysis of adhesions; stoma revisions), two (18.2%) had received a NIPAA approach and nine (81.8%) had received a TIPAA. Two children having TIPPA, because of chronic pain and failure to achieve full continence elected placement of a diverting ileostomy.
Conclusions:
This study suggests that children with medically-refractory UC treated by either NIPAA or TIPAA have similar outcomes. Minimal differences in overall outcome following either apporach are noted. However, performing an ileo-pouch anastomosis as a second stage procedure without a stoma may be associated with reduced reliance on antidiarrhea medications once intestinal continuity is restored.