Histologic inflammatory activity of the rectal margin as a predictor of postoperative complication in ileoanal anastomosis (J-pouch) procedure in children with refractory ulcerative colitis

Abstract

BackgroundPostoperative complication from the ileoanal anastomosis (J-pouch) procedure for surgical management of refractory ulcerative colitis (UC) increases the risk of pouch dysfunction. The purpose of this study was to determine if histologic inflammatory activity of the rectal margin is an independent predictor of complication after controlling for other variables. MethodsA retrospective chart review was performed to identify all pediatric patients with UC who underwent a J-pouch procedure between 1995 and 2014. Univariate and multivariate regression analyses were performed on the following variables: age at surgery, body mass index, comorbidities, time between colectomy and pouch, mucosectomy, protective ileostomy status, length of pouch, and histologic inflammatory activity in the intestinal epithelium of the rectal margin. ResultsNineteen complicated and 23 uncomplicated cases were included. Histologic inflammatory activity was significantly higher among the complicated group (9.3±3.1 vs. 4.1±3.1, p=0.02). No significant difference was found regarding other variables. In a multivariate regression, histologic inflammation of the rectal margin remained significantly associated with complication (p=0.04) after adjusting for other factors. ConclusionAfter controlling for potential confounders, histologic inflammatory activity at the rectal margin was found to be a significant predictor of postoperative complication in the J-pouch procedure for refractory UC.Level of evidence: 2b.