Restorative proctocolectomy without diverting ileostomy in children with ulcerative colitis

Gray, Brian W.; Drongowski, Robert A.; Hirschl, Ronald B.; Geiger, James D.

doi:10.1016/j.jpedsurg.2011.10.041

Cited by 31 publications

(14 citation statements)

References 15 publications

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“…Restorative proctocolectomy and pouch formation without a covering ileostomy has been reported with several single centre series documenting no increased morbidity, with regards to anastomotic leak/stricture or episodes of pouchitis. However, the retrospective data in these series and the relatively small patient numbers would preclude any statistically significant differences (71,72) and consequently guidelines recommend a covering ileostomy (64).…”

Section: Elective Surgery For Ambulant Patientsmentioning

confidence: 99%

Surgery and paediatric inflammatory bowel disease

Kelay¹,

Tullie²,

Stanton³

2019

Transl Pediatr

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The incidence of both Crohn's disease (CD) and ulcerative colitis (UC) is increasing in children. Surgical intervention is required in a proportion of cases. For example, two recent studies reported that, for patients diagnosed at age <17 years, the risk of requiring surgery during childhood to be 24% for CD and 9% for UC (1,2). In this cohort, diagnosis preceded surgery by median 9 months for CD and 2.2 years for UC. There appears to be evidence that the rate of surgery undertaken in children for paediatric inflammatory bowel disease (PIBD) is reducing in the era following the introduction of biological therapy (3). It is not clear yet as to whether this merely represents a delay in the timing of inevitable surgery, or a true reduction in the lifetime risk of requiring surgery. CD Indications for surgery EmergencyIn the emergency setting, absolute indications for surgical intervention include perforation and complete bowel

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Section: Elective Surgery For Ambulant Patientsmentioning

confidence: 99%

Surgery and paediatric inflammatory bowel disease

Kelay¹,

Tullie²,

Stanton³

2019

Transl Pediatr

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“…We excluded 24 records, with reasons detailed in Appendix B. [18][19][20][21][22][23][24][25][26][27]12,[28][29][30][31][32]7,11,[33][34][35][36][37][38] This included studies that compared RPC-IPAA staged approaches but did not stratify by our intervention of interest(i.e. modified 2-stage approach).…”

Section: Study Selectionmentioning

confidence: 99%

Modified two-stage restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review and meta-analysis of observational research

Luo

Singh

Cuomo

et al. 2020

Int J Colorectal Dis

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Purpose: Restorative proctocolectomy(RPC) is performed for patients with refractory ulcerative colitis(UC). This operation is performed in 2 or 3-stages and involves forming a diverting loop ileostomy thought to protect patients from complications related to anastomotic leak. However, some advocate for a modified 2-stage approach, consisting of subtotal colectomy followed by completion proctectomy and ileal pouch anal anastomosis without diverting ileostomy. We present a systematic review and meta-analysis comparing postoperative complication rates between modified 2-stage and traditional RPC with ileal pouch anal anastomosis.Methods: Records were sourced from PubMed/Embase databases. Studies comparing postoperative complications following RPC for ulcerative colitis(UC) were selected according to PRISMA guidelines comparing modified 2-stage(exposure), classic 2-stage, and 3-stage approaches(comparators). The primary outcome measure was safety as measured by postoperative complication rates. We employed random-effects meta-analysis. Results:We included ten observational studies including 1727 patients(38% modified 2-stage). Among pediatric patients, modified 2-stage approaches had higher rates of anastomotic leak than 3-stage approaches(p=0.03). Among adult cohorts with lower preoperative biologic use rates, modified 2-stage approaches had lower leak rates than classic 2-stage approaches(p<0.001). Conclusions:The modified 2-stage approach may be safe for adult patients who otherwise require a 3-stage approach while reducing costs and length of stay. Pediatric patients may benefit

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“…[22][23][24][25] Four (67%) stratified baseline characteristics, such as age, sex, duration of Open access illness before resection or immunosuppression at time of surgery. [22][23][24][25] Indications for surgery included chronic anal pain and failure to achieve full continence (one study (17%)) 22 and acute presentation of UC refractory to medical intervention (one (17%)). 20 One study (17%) included an urgent case in their cohort.…”

Section: Study Characteristics and Individual Resultsmentioning

confidence: 99%

Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

Oltean

Travis

Kaur

et al. 2022

World Jnl Ped Surgery

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BackgroundThe efficacy of performing a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting ileostomy in children with inflammatory bowel disease has been a longstanding debate. A systematic review and meta-analysis is presented comparing the occurrence of postoperative complications in children who underwent either the pouch-anal anastomosis (IPAA) with ileostomy (diverted) versus the undiverted procedure.MethodsRecords were sourced from CINAHL, CENTRAL, EMBASE and MEDLINE databases. Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and compared postoperative complications in pediatric patients diagnosed with inflammatory diseases aged less than 18 years who underwent J-pouch with ileostomy versus without ileostomy. The primary outcome was the occurrence of postoperative leaks, and the secondary outcomes were presence of postoperative small bowel obstruction (SBO), pouchitis, stricture and fistula complications. A random-effects meta-analysis was used.ResultsTwenty-three observational studies in the systematic review were included with 658 patients (83% diverted, 17% undiverted). Pooled estimates showed no difference in occurrence of leaks in children who underwent J-pouch/IPAA with ileostomy versus without (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.17 to 1.64, I2=16%). There was no difference in the occurrence of SBO, pouchitis or strictures in children who underwent J-pouch/IPAA with ileostomy versus without (SBO: OR 2.27, 95% CI 0.52 to 9.92, I2=0%, pouchitis: OR 1.76, 95% CI 0.95 to 3.24, I2=0%, strictures: OR 2.72, 95% CI 0.44 to 16.69, I2=66%).ConclusionThe meta-analysis did not find differences in the occurrence of complications in pediatric patients who underwent the IPAA with ileostomy procedure versus without ileostomy.

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Restorative proctocolectomy without diverting ileostomy in children with ulcerative colitis

Cited by 31 publications

References 15 publications

Surgery and paediatric inflammatory bowel disease

Surgery and paediatric inflammatory bowel disease

Modified two-stage restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review and meta-analysis of observational research

Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

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