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

J Pediatr Surg. 2021 Jun;56(6):1203-1207. doi: 10.1016/j.jpedsurg.2021.02.023. Epub 2021 Feb 20.

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.

Keywords: Pediatrics; Surgery; Ulcerative colitis.

MeSH terms

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