Background: We aimed to evaluate contemporary surgical complications rate and pouch function following proctocolectomy and ileal pouch anal anastomosis (IPAA) in children with ulcerative colitis (UC)/inflammatory bowel disease unclassified (IBDU) undergoing the procedure before 18 years of age. Outcomes related to pouchitis are reported separately.
Methods: This was a multicentre longitudinal retrospective study involving 17 paediatric IBD centres from the Porto group of ESPGHAN. An electronic REDcap system was used to collate explicit baseline characteristics, clinical, management and surgical data, including short and long term outcomes.
Results: A total of 129 children after IPAA were included (50% male; 93% UC and 7% IBDU). Mean age at diagnosis was 10.5±4.2 years and median disease duration to colectomy was 17 months (IQR 8–36 months). Median post-operative follow-up was 40 months (IQR 26–72 month). Nineteen patients (15%) underwent proctocolectomy before age 10. A two-staged procedure was performed in 76 patients (59%), 3-stage in 45 (35%) and one-stage in 8 (6%). 48 patients (38%) underwent a laparoscopic assisted colectomy. Median number of bowel movements (BM)/24 hours one year after surgery was 5 (IQR 4–6; range 2–12). 42 patients (40%) had nocturnal BM one year post surgery even when pouchitis-free, of whom 48% had up to 1 nocturnal BM and 52% had greater than 1. One month and one year post-IPAA, 31 (28%) and 31 (28%) children used anti-diarrheal medication, respectively. Physician global assessment (PGA) of overall pouch performance was rated good or excellent in 71 (66%) patients at 1 month, 79 (71%) at 1 year post-IPAA, and 86 patients (74%) at last follow-up. Neither number of BM nor PGA were associated with surgical technique (lap/open) or with age <10 at colectomy.
Within 1 month after colectomy, 41 patients (34%) had surgical complications. The most common complications were small bowel obstruction in 14 (12%) and wound infection in 9 patients (7%). Within 1 month of pouch formation 33 patients (30%) had surgical complications. There was no association between surgical complications and surgical technique (lap/open). Patients with colectomy before age 10 had significantly more surgical complications at 1 year post IPAA. Pouch related outcomes included pouch stricture in 14 (11%) patients, pouch fistula in 12 (9%), prolapse in 3 (2.3%), pelvic floor in one (0.8%) and anal sphincter dysfunction in 1 (0.8%).
Conclusions: Surgical complications occurred in many children undergoing IPAA for UC/IBDU. Age younger than 10 years at proctocolectomy was associated with higher long term surgical complications but comparable pouch function. Pouch function was rated excellent or good in the majority of patients at last follow-up (74%).