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Variables associated with loss of ileoanal pouches constructed in childhood.
J Pediatr Surg 2017; 52(2):281-285JP

Abstract

AIMS

To quantify the incidence of loss of an ileoanal pouch in children and to identify variables associated this event.

METHODS

Logistic regression of possible explanatory variables: age, sex, indication for procto-colectomy, pre-operative continence status, use of immunosuppressive drugs, open or laparoscopic surgery, number of stages, anastomotic leak, operative complication excluding anastomotic leak, performance of revisional surgery, albumin concentration and platelet count at time of surgery, rank order in series. Univariate logistic regression was used to identify significant variables which were then assessed in a multivariate model and construction of Kaplan-Meier graphs.

RESULTS

103 children, 56 girls, underwent ileoanal pouch at median age 14years (SD 3.7). Indications and mean age were: ulcerative colitis (n=71, 14years), polyposis syndromes (n=13, 15years), chronic idiopathic constipation (n=9, 11years), Hirschsprung's disease (n=4, 1year), Crohn's disease (n=2, 16years), and fibrosing colonopathy (n=2, 11years). 13 patients had their pouch excised or permanently diverted. Three patients had successful revisional pouch surgery. Only pre-operative fecal incontinence and anastomotic leak were significantly associated with pouch excision/diversion, however on multivariate analysis, only fecal incontinence remained significant, odds ratio 21 (95%CI 1.8-235, p=0.01). Pouch survival was significantly worse where there was fecal incontinence pre-operatively, p<0.0001 or an anastomotic leak, p<0.001.

CONCLUSIONS

13% of children subjected to restorative procto-colectomy ultimately receive a permanent ileostomy. Fecal incontinence prior to surgery is a relative contra-indication. Anastomotic leak increases the probability of later pouch excision.

LEVEL OF EVIDENCE

IV.

Authors+Show Affiliations

Department of paediatric surgery, The Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne NE1 4LP.Department of paediatric surgery, The Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne NE1 4LP. Electronic address: bruce.jaffray@nuth.nhs.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27890312

Citation

Abdelaal, Khaled, and Bruce Jaffray. "Variables Associated With Loss of Ileoanal Pouches Constructed in Childhood." Journal of Pediatric Surgery, vol. 52, no. 2, 2017, pp. 281-285.
Abdelaal K, Jaffray B. Variables associated with loss of ileoanal pouches constructed in childhood. J Pediatr Surg. 2017;52(2):281-285.
Abdelaal, K., & Jaffray, B. (2017). Variables associated with loss of ileoanal pouches constructed in childhood. Journal of Pediatric Surgery, 52(2), pp. 281-285. doi:10.1016/j.jpedsurg.2016.11.017.
Abdelaal K, Jaffray B. Variables Associated With Loss of Ileoanal Pouches Constructed in Childhood. J Pediatr Surg. 2017;52(2):281-285. PubMed PMID: 27890312.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variables associated with loss of ileoanal pouches constructed in childhood. AU - Abdelaal,Khaled, AU - Jaffray,Bruce, Y1 - 2016/11/13/ PY - 2016/11/04/received PY - 2016/11/08/accepted PY - 2016/11/29/pubmed PY - 2017/2/16/medline PY - 2016/11/29/entrez KW - Ileoanal pouch KW - Restorative proctocolectomy KW - Survival SP - 281 EP - 285 JF - Journal of pediatric surgery JO - J. Pediatr. Surg. VL - 52 IS - 2 N2 - AIMS: To quantify the incidence of loss of an ileoanal pouch in children and to identify variables associated this event. METHODS: Logistic regression of possible explanatory variables: age, sex, indication for procto-colectomy, pre-operative continence status, use of immunosuppressive drugs, open or laparoscopic surgery, number of stages, anastomotic leak, operative complication excluding anastomotic leak, performance of revisional surgery, albumin concentration and platelet count at time of surgery, rank order in series. Univariate logistic regression was used to identify significant variables which were then assessed in a multivariate model and construction of Kaplan-Meier graphs. RESULTS: 103 children, 56 girls, underwent ileoanal pouch at median age 14years (SD 3.7). Indications and mean age were: ulcerative colitis (n=71, 14years), polyposis syndromes (n=13, 15years), chronic idiopathic constipation (n=9, 11years), Hirschsprung's disease (n=4, 1year), Crohn's disease (n=2, 16years), and fibrosing colonopathy (n=2, 11years). 13 patients had their pouch excised or permanently diverted. Three patients had successful revisional pouch surgery. Only pre-operative fecal incontinence and anastomotic leak were significantly associated with pouch excision/diversion, however on multivariate analysis, only fecal incontinence remained significant, odds ratio 21 (95%CI 1.8-235, p=0.01). Pouch survival was significantly worse where there was fecal incontinence pre-operatively, p<0.0001 or an anastomotic leak, p<0.001. CONCLUSIONS: 13% of children subjected to restorative procto-colectomy ultimately receive a permanent ileostomy. Fecal incontinence prior to surgery is a relative contra-indication. Anastomotic leak increases the probability of later pouch excision. LEVEL OF EVIDENCE: IV. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/27890312/Variables_associated_with_loss_of_ileoanal_pouches_constructed_in_childhood L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(16)30549-8 DB - PRIME DP - Unbound Medicine ER -