P278 Short and long-term surgical outcomes and pouch function following proctocolectomy and pouch formation in paediatric ulcerative colitis: a multicentre-retrospective cohort study from the Porto IBD working group of ESPGHAN
Orlanski Meyer E.*1, Topf-Olivestone C.1, Shtayer E.1, Tulchinsky H.2, Hansen L.-F.3, Kindermann A.4, Assa A.5, Kolho K.-L.6, Kolaček S.7, Carroll M.W.8, Martinelli M.9, Aloi M.10, Hansen R.11, Winter H.S.12, Navas-Lόpez V.M.13, Weiss B.14, Shah N.15, Turner D.1
1Shaare Zedek Medical Center, The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Jerusalem, Israel 2Tel Aviv Sourasky Medical Center, Tel Aviv University, Department of Surgery, Tel Aviv, Israel 3Hvidovre University Hospital, Department of Pediatrics, Copenhagen, Denmark 4AMC Medical Centre-Emma Children's Hospital, Department of Paediatric Gastroenterology, Amsterdam, Netherlands 5Schneider Children's Medical Center, Institute of Gastroenterology, Nutrition and Liver disease, Petach Tikva, Israel 6Children's Hospital, University of Helsinki, Helsinki, Finland 7Children's Hospital Zagreb, Referral Center for Paediatric Gastroenterology & Nutrition, Zagreb, Croatia 8Stollery Children's Hospital, University of Alberta, Pediatric Gastroenterologist, Division of GI & Nutrition, Alberta, Canada 9University of Naples “Federico II”, Department of Translational Medical Science, Section of Pediatrics, Naples, Italy 10Sapienza University of Rome, Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Rome, Italy 11Glasgow Children's Hospital, Consultant Paediatric Gastroenterologist, Glasgow-Scotland, United Kingdom 12MassGeneral Hospital for Children, Pediatric IBD, Boston, Massachusetts, United States 13Hospital Materno Infantil, Pediatric Gastroenterology and Nutrition Unit, Málaga, Spain 14Edmond & Lily Safra Children's Hospital, Tel- Hashomer, Pediatric Gastroenterology& Nutrition Unit, Tel Aviv, Israel 15Great Ormond Street Hospital, London, United Kingdom
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.
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.
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%).
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%).