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Is fecal diversion necessary during ileal pouch creation after initial subtotal colectomy in pediatric ulcerative colitis?

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Abstract

Background

Pediatric patients with medically refractory ulcerative colitis (UC) often undergo an initial subtotal colectomy end ileostomy (STC-I). The role of fecal diversion in the subsequent completion proctectomy/ileal-pouch anal anastomosis (CP-IPAA) remains controversial.

Methods

A multi-institutional retrospective review was performed of pediatric UC patients who underwent an STC-I followed by CP-IPAA from 2008 to 2016. 37 patients were included [diverted (n = 20), undiverted (n = 17)].

Results

Children who underwent undiverted CP-IPAA had a longer length of stay (days) compared to the diverted group (9, 6.5–13 vs. 6, 5–6, p = 0.002). The 30-day complication rate was significantly higher in the undiverted group (p = 0.003) although the difference in anastomotic leak, readmission rate, unplanned computer tomography use, and reoperation was not statistically significant. Three patients with undiverted CP-IPAA required additional surgery in the perioperative period for fecal diversion. The mean long-term follow-up was 25.68 ± 21.56 months. There were no significant differences in functional pouch outcomes.

Conclusions

Patients who underwent an undiverted CP-IPAA after initial STC-I had significantly more complications in the immediate postoperative period compared to diverted patients, although this did not translate into long-term differences in functional outcomes. Questions remain regarding careful patient selection and counseling for undiverted pouches in the pediatric UC population.

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Authors and Affiliations

  1. The Moses Division of Colon and Rectal Surgery, The Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 15th Floor, Box 1259, New York, NY, 10029, USA

    Y. Julia Chen, Robert Grant, Sergey Khaitov & Alexander Greenstein

  2. Division of Pediatric Surgery, Cohen Children’s Medical Center, New Hyde Park, NY, USA

    Erika Lindholm, Aaron Lipskar & Stephen Dolgin

Authors
  1. Y. Julia Chen
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  2. Robert Grant
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  3. Erika Lindholm
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  4. Aaron Lipskar
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  5. Stephen Dolgin
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  6. Sergey Khaitov
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  7. Alexander Greenstein
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Correspondence to Robert Grant.

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The authors declare that they have no conflicts of interest.

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For this type of study formal consent is not required. This article does not contain any studies with animals performed by the authors.

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Chen, Y.J., Grant, R., Lindholm, E. et al. Is fecal diversion necessary during ileal pouch creation after initial subtotal colectomy in pediatric ulcerative colitis?. Pediatr Surg Int 35, 443–448 (2019). https://doi.org/10.1007/s00383-019-04440-1

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  • DOI: https://doi.org/10.1007/s00383-019-04440-1

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