Is fecal diversion necessary during ileal pouch creation after initial subtotal colectomy in pediatric ulcerative colitis?
Pediatr Surg Int
; 35(4): 443-448, 2019 Apr.
Article
em En
| MEDLINE
| ID: mdl-30661100
ABSTRACT
BACKGROUND:
Pediatric patients with medically refractory ulcerative colitis (UC) often undergo an initial subtotal colectomy end ileostomy (STC-I). The role of fecal diversion in the subsequent completion proctectomy/ileal-pouch anal anastomosis (CP-IPAA) remains controversial.METHODS:
A multi-institutional retrospective review was performed of pediatric UC patients who underwent an STC-I followed by CP-IPAA from 2008 to 2016. 37 patients were included [diverted (n = 20), undiverted (n = 17)].RESULTS:
Children who underwent undiverted CP-IPAA had a longer length of stay (days) compared to the diverted group (9, 6.5-13 vs. 6, 5-6, p = 0.002). The 30-day complication rate was significantly higher in the undiverted group (p = 0.003) although the difference in anastomotic leak, readmission rate, unplanned computer tomography use, and reoperation was not statistically significant. Three patients with undiverted CP-IPAA required additional surgery in the perioperative period for fecal diversion. The mean long-term follow-up was 25.68 ± 21.56 months. There were no significant differences in functional pouch outcomes.CONCLUSIONS:
Patients who underwent an undiverted CP-IPAA after initial STC-I had significantly more complications in the immediate postoperative period compared to diverted patients, although this did not translate into long-term differences in functional outcomes. Questions remain regarding careful patient selection and counseling for undiverted pouches in the pediatric UC population.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Colite Ulcerativa
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Proctocolectomia Restauradora
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Bolsas Cólicas
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Defecação
/
Fístula Anastomótica
Tipo de estudo:
Observational_studies
Limite:
Adolescent
/
Female
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Humans
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Male
Idioma:
En
Revista:
Pediatr Surg Int
Assunto da revista:
PEDIATRIA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Estados Unidos