Short-term outcomes in children undergoing restorative proctocolectomy with ileal-pouch anal anastomosis.

Autor: Dukleska K; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA., Berman L; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA; Department of Surgery, A.I. duPont Hospital for Children, Wilmington, DE., Aka AA; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA., Vinocur CD; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA; Department of Surgery, A.I. duPont Hospital for Children, Wilmington, DE., Teeple EA; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA; Department of Surgery, A.I. duPont Hospital for Children, Wilmington, DE. Electronic address: Erin.Teeple@nemours.org.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2018 Jun; Vol. 53 (6), pp. 1154-1159. Date of Electronic Publication: 2018 Mar 07.
DOI: 10.1016/j.jpedsurg.2018.02.075
Abstrakt: Introduction: Patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) commonly undergo restorative proctocolectomy with ileal-pouch anal anastomosis (RP-IPAA). We sought to describe patient characteristics and postoperative outcomes in this patient population.
Methods: Using the National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012 to 2015, children who were 6-18years old who underwent RP-IPAA for FAP or UC were identified. Postoperative morbidity, including reoperation and readmission were quantified. Associations between preoperative characteristics and postoperative outcomes were analyzed.
Results: A total of 260 children met the inclusion criteria, of which 56.2% had UC. Most cases were performed laparoscopically (58.1%), and the operative time was longer with a laparoscopic versus open approach (326 [257-408] versus 281 [216-391] minutes, p=0.02). The overall morbidity was 11.5%, and there were high reoperation and readmission rates (12.7% and 21.5%, respectively). On bivariate analysis, preoperative steroid use was associated with reoperation (22.5% versus 10.9%, p=0.04). On multivariable regression analysis, obesity was independently associated with reoperation (odds ratio: 3.34 [95% confidence intervals: 1.08-10.38], p=0.04).
Conclusions: Children who undergo RP-IPAA have high rates of overall morbidity, reoperation, and readmission. Obesity was independently associated with reoperation. This data can be used by practitioners in the preoperative setting to better counsel families and establish expectations for the postoperative setting.
Type of Study: Retrospective Comparative Study.
Level of Evidence: Level III.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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