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J Crohns Colitis. 2018 Nov 3. doi: 10.1093/ecco-jcc/jjy175. [Epub ahead of print]

Long-term single center outcomes after proctocolectomy with ileoanal anastomosis for paediatric ulcerative colitis.

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Section of Paediatric Surgery.
Section of Paediatric Gastroenterology Children's Hospital, Helsinki University Hospital and University of Helsinki.
Tampere University Hospital and University of Tampere, Tampere, Finland.


Background and Aims:

Childhood-onset ulcerative colitis (UC) requires total colectomy in one quarter of patients at some point of their disease. The study objective was to evaluate long-term outcomes after proctocolectomy with ileoanal anastomosis (IAA) for UC.


Medical records of all children undergoing proctocolectomy with IAA for UC during 1985-2016 in Helsinki University Hospital were retrospectively assessed. Data on disease history, diagnostic and operative details, occurrence of surgical complications, functional outcome, postoperative diagnosis of Crohn's disease (CD) and pouch failure were collected. Risk factors for IAA failure were analysed with Cox regression.


Of 87 patients, 85 (98%) had UC and 2 (2%) IBD-U preoperatively. Altogether 66% underwent two-stage and 34% three-stage procedures. During 7.8 (4.1-14.5) years' follow-up, nine (10%) patients were diagnosed with postoperative CD. Postoperative leakages (n=8, 9%) and strictures (n=10, 11%) were equally common while fistulas (78% vs. 9%, p<0.001) and abscesses (56% vs 14%, p=0.009) more frequent among patients with later CD diagnosis. At last follow-up, eight (9%) patients had been converted to a permanent ileostomy while others reported daytime stooling frequency of 5 (4-7) and 0.5 (0-1) at night. CD diagnosis (hazard ratio, HR=23.3, p=0.005), postoperative abscesses (HR=16.3, p=0.013) and fistulas (HR=20.9, p=0.007) as well as 3-stage surgery (p=0.018) increased risk for ileostomy.


For paediatric UC, long-term surgical and functional outcomes after proctocolectomy with IAA are reassuring. Need for 3-stage surgery, postoperative fistulas and abscesses, but not leakages or strictures, associate with postoperative CD diagnosis and the risk for ileostomy.


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