Functional outcomes and quality of life after restorative proctocolectomy in paediatric patients: a case-control study.

Gianluca Pellino,Francesco Selvaggi,Giuseppe Candilio,Annamaria Staiano,Gabriele Riegler,Erasmo Miele,Guido Sciaudone,Gilda Serena De Fatico,Silvestro Canonico

doi:10.1155/2014/340341

Abstract

Background. Restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) has some peculiarities in paediatric ulcerative colitis (UC). Aims. The primary aim was to compare the bowel function of patients undergoing IPAA between those operated on in childhood and adulthood. The secondary aim was to compare the quality of life (QoL) and outcomes for children between medical and surgical therapies. Method. Children undergoing IPAA were compared with adult patients undergoing IPAA between 2007 and 2012. Function was assessed 1 year after ileostomy closure. Function and QoL of medically managed paediatric patients were compared with their surgical counterparts. Results. Twelve paediatric IPAA patients were compared with 24 adult ones. Acute presentation was common in the former, usually after failed biological treatment. Recurrent pouchitis was more frequent in children. Younger patients exhibited a trend toward better discrimination and continence. QoL was excellent in both groups. Twelve medically treated children were enrolled for secondary aim. Functioning was similar in IPAA- and medically managed children, but the former had a better QoL, confirmed by parents' perception. Conclusions. Similar function is achieved by IPAA in childhood or adulthood. IPAA may offer a better QoL compared to prolonged medical management. The beneficial effects of IPAA experienced by children were similarly observed by their parents.

Highlights

Restorative proctocolectomy involving the formation of an ileal pouch and ileal-pouch anal anastomosis (IPAA) is the treatment of choice for refractory or complicated ulcerative colitis (UC) [1]
Twenty-four adult UC patients with IPAA and 12 age-matched, paediatric UC patients who were managed with medical treatment during the study period served as controls for the primary and secondary aims, respectively
We evaluated quality of life (QoL) using the Pediatric Quality of Life Inventory QoL (PedsQL) Short Form-15 (SF-15)

Summary

Introduction

Restorative proctocolectomy involving the formation of an ileal pouch and ileal-pouch anal anastomosis (IPAA) is the treatment of choice for refractory or complicated ulcerative colitis (UC) [1]. IPAA is regarded as the mainstay treatment for UC in both the elderly [2] and the paediatric population [3] This is a very complex procedure, and inadequate data exist comparing the functional outcomes of patients undergoing IPAA for UC between those operated on in childhood and adulthood. The secondary aim was to compare the bowel function and quality of life (QoL) of children diagnosed with UC between those undergoing IPAA and those treated medically. The primary aim was to compare the bowel function of patients undergoing IPAA between those operated on in childhood and adulthood. The secondary aim was to compare the quality of life (QoL) and outcomes for children between medical and surgical therapies. Function and QoL of medically managed paediatric patients were compared with their surgical counterparts. The beneficial effects of IPAA experienced by children were observed by their parents

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