Pediatric Surgery International | 2021
Single-stage restorative proctocolectomy for ulcerative colitis in pediatric patients: a safe alternative
Abstract
Surgical management for refractory ulcerative colitis (UC) has been restorative proctocolectomy (RP) with ileal-pouch-anal-anastomosis (IPAA) done as one to three stages, with safety and effectiveness of a single-stage operation unclear. Pediatric UC patients from 2004 to 2019 who underwent RP/IPAA in the initial operation were retrospectively reviewed. 1-stage operations were matched 1:2 to 2-stage operations using age, duration of disease, and disease severity. Ninety-nine patients (33 1-stage, 66 2-stage) were identified. The median total operative time was shorter in the 1-stage group (6 h:00 min vs. 7 h:47 min, p\u2009=\u20090.004). Total length of stay was shorter in the 1-stage group (9 vs. 17 days, p\u2009=\u20090.001). Rates of readmission were higher in 2-stage group (30 vs. 9%, p\u2009=\u20090.02). There was no difference in pouch leak rates (p\u2009=\u20091.00). Stricture rates were higher in the 2-stage group (50 vs. 16%, p\u2009=\u20090.005). Functional outcomes including pouchitis (p\u2009=\u20090.13), daily bowel movements (p\u2009=\u20090.37), and incontinence (p\u2009=\u20090.77) were all similar. Restorative proctocolectomy with IPAA in children with UC can be performed as a 1- or 2-stage operation with equivalent short-term, long-term, and functional outcomes in similar risk population. Our findings suggest 1-stage RP/IPAA operations without ileostomy are a safe alternative for patients considered for a 2-stage operation.