Pediatric and Adult Patients Had a Similar Pouch Survival Rate After Restorative Proctocolectomy

Abstract

There were limited data in the literature on the long-term pouch outcomes in children who underwent restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). The aim of this study was to compare long-term pouch outcomes in pediatric and adult patients. Consecutive inflammatory bowel disease (IBD) patients with ileal pouches seen in our Pouchitis Clinic from 2002-2012 were studied. The pouch outcome in pediatric patients was evaluated in comparison with adults by both univariate and multivariate analyses. All eligible patients were included into the study (N = 1,289), of whom 108 (8.4%) were pediatric patients (<18 years). Male accounted for 50.9% of pediatric patients and 55.5% of adults. Pediatric patients had a younger age at the time of IBD diagnosis and pouch construction and a shorter duration from IBD diagnosis to colectomy. Fewer pediatric patients had a history of smoking (9.3% vs. 20.7%, P = 0.004), concomitant extra-intestinal manifestations (21.5% vs. 39.1%, P < 0.001), and dysplasia as the indication for colectomy (0.9% vs. 13.6%, P < 0.001) than the adults. On the other hand, pediatric patients had higher rates of pouch surgery-associated complications (21.3% vs. 13.9%, P = 0.036), postoperative pouch-associated hospitalization (25.9% vs. 13.4%, P < 0.001) and postoperative use of anti-TNF biologics (16.7% vs. 7.9%, P = 0.002) than the adults. Pouch failed in 100 patients (7.8%) after a mean follow-up of 10.6±6.8 years, including 13(12.0%) in the pediatric group and 87 (7.4%) in the adult group (P = 0.082). Risk factors for pouch failure in the multivariate analysis included preoperative use of anti-TNF biologics, postoperative use of anti-TNF biologics, Crohn's disease of pouch, pouch surgery-related complications and postoperative pouch-associated hospitalization. However, pediatric patients were not found to be significantly associated with pouch failure in neither the univariate nor multivariate analyses, with a hazard ratio of 0.67 (95% confidence interval: 0.36-1.24, P = 0.2) from the multivariate analysis. Pediatric patients suffered from a higher incidence of postoperative pouch complications than adults; however the long-term pouch retention rates were comparable.