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Is fecal diversion necessary during ileal pouch creation after initial subtotal colectomy in pediatric ulcerative colitis?

  • Y. Julia Chen
  • Robert GrantEmail author
  • Erika Lindholm
  • Aaron Lipskar
  • Stephen Dolgin
  • Sergey Khaitov
  • Alexander Greenstein
Original Article
  • 35 Downloads

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.

Keywords

Ulcerative colitis IPAA Ileostomy J pouch 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

For this type of study formal consent is not required. This article does not contain any studies with animals performed by the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Moses Division of Colon and Rectal Surgery, The Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Division of Pediatric SurgeryCohen Children’s Medical CenterNew Hyde ParkUSA

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