Does the timing of pouch creation in 2-stage operations for pediatric patients with ulcerative colitis matter?

Abstract

INTRODUCTION:

Children with fulminant ulcerative colitis(UC) traditionally undergo 2-stage operations: restorative-proctocolectomy(RP/IPAA) and ileostomy followed by ostomy closure. In the biologic era, surgeons have modified their strategy: initial subtotal-colectomy/diversion, followed by RP/IPAA without diversion. Yet, evidence on efficacy and functional outcomes with the "modified 2-stage" approach is limited in children. We sought to compare the timing of pouch creation in 2-stage operations to determine outcomes.

METHODS:

This is a retrospective study of children with UC undergoing either a traditional 2-stage RP/IPAA or modified 2-stage RP/IPAA between 2010 and 2019. Complications (leak, stricture, wound-infection) were recorded at 90-days and 1 year from 2nd operation.

RESULTS:

N = 57 (Traditional n = 40, Modified n = 17). Median time to surgery from consultation was shorter in the modified-group (7 vs.25 days, p = 0.01). Preoperatively, the modified-group had lower albumin(p = 0.01), higher CRP(p = 0.01), and more frequently took biologics within 90-daysp=0.001). After re-establishing intestinal continuity, stricture requiring dilation was higher in the traditional-group (59% vs.18%, p = 0.008). No difference in pouch leak (p = 0.38), bowel obstruction(p = 0.35), loperamide dose(p = 0.21), or incontinence(p = 0.38) was observed.

CONCLUSION:

Delaying pouch creation to the second operation without a protective ileostomy as a modified 2-stage is safe in a sicker and more acute pediatric population.

• Authors: Nathan S Rubalcava, Natalie A Moreno, Jeremy Adler, James D Geiger, Ronald B Hirschl, Samir K Gadepalli
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 56 Issue 6 Pg. 1203-1207 (Jun 2021) ISSN: 1531-5037 [Electronic] United States
• PMID: 33741179 (Publication Type: Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Inc.

Topics

• Child
• Colectomy
• Colitis, Ulcerative (surgery)
• Colonic Pouches
• Humans
• Ileostomy
• Postoperative Complications (epidemiology, etiology)
• Proctocolectomy, Restorative
• Retrospective Studies
• Treatment Outcome