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Medline ® Abstract for Reference 50

of 'Management of severe or refractory ulcerative colitis in children and adolescents'

Long-term outcomes of ileal pouch-anal anastomosis for pediatric chronic ulcerative colitis.
Polites SF, Potter DD, Moir CR, Zarroug AE, Stephens MC, Tung J, Pavey ES, Harmsen WS, Pemberton JH
J Pediatr Surg. 2015 Oct;50(10):1625-9. Epub 2015 Mar 26.
BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with chronic ulcerative colitis (CUC). In the pediatric population, short-term outcomes of IPAA are excellent but long-term data limited. The purpose of this study is to report long-term functional and quality of life outcomes of IPAA in pediatric patients.
METHODS: Functional outcomes and quality of life (QoL) following IPAA in patients≤18years of age were prospectively assessed by survey over a 30year period. Preoperative information, chronic pouchitis and pouch loss were retrospectively reviewed.
RESULTS: Over 30years, 202 children with CUC underwent IPAA. Questionnaires were returned by 87% and median (range) survey follow-up was 181.5 (7.8-378.5) months. Postoperative day and night-time stool frequency did not increase over time though incontinence increased slightly. Quality of life (QoL) was generally excellent and stable over time. Crohn's disease (CD) was diagnosed in 33 (16%) patients during the follow-up period. Chronic pouchitis occurred in 22 patients and pouch failure in 13 patients. Kaplan Meier estimates of pouch survival at 20years were 61% for patients with CD and 92% for CUC.
CONCLUSIONS: Ileal pouch-anal anastomosis has long-term durability as a cure for pediatric chronic ulcerative colitis, with most patients reporting stable bowel function and QoL. Chronic pouchitis and pouch failure affect a minority of patients and require further study.
Department of Surgery, Mayo Clinic, Rochester, Minnesota.