Acute histologic inflammatory activity and postoperative outcomes in pediatric patients with ulcerative colitis - 09/04/20

Doi : 10.1016/j.amjsurg.2020.02.054

Ekene Onwuka ^a,^b,^⁎,^{^{1
Shared first authorship.}} , Justin Huntington ^a,^b,^{^{1
Shared first authorship.}} , Amanda Onwuka ^c , Vinay Prasad ^d,^{^{2
Permanent address: Monroe Carrell Jr. Children’s Hospital at Vanderbilt, 2200 Children’s WayNashville, TN 37232, USANashville, TN 37232, USA.}} , Benedict Nwomeh ^a,^b
^a Nationwide Children’s Hospital, Division of Pediatric Surgery, 700 Children’s Dr., Columbus, OH, 43205, USA
^b The Ohio State University College of Medicine, Department of Surgery, 395 W. 12th Ave, Columbus, OH, 43210, USA
^c University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
^d Nationwide Children’s Hospital, Division of Pathology, 700 Children’s Dr, Columbus, OH, 43205, USA

^∗Corresponding author. Nationwide Children’s Hospital, Division of Pediatric Surgery; 700 Children’s Dr, Columbus, OH, 43205, USA.Nationwide Children’s HospitalDivision of Pediatric Surgery700 Children’s DrColumbusOH43205USA

Abstract

Background

The aim of this study was to determine whether acute histologic inflammatory activity at the rectal margin predicts postoperative complications in children with ulcerative colitis following ileal pouch-anal anastomoses (IPAA).

Methods

Patients who underwent IPAA following previous total abdominal colectomy for ulcerative colitis between 2006 and 2014 were included. Data collected included demographics, operative and postoperative data, histologic grading of the rectal margin at time of IPAA, and stooling outcomes at one, six and 12 months following ileostomy closure.

Results

Twenty-seven patients were included. Acute inflammation scores ranged between 2 and 13. Unadjusted and adjusted models showed no statistically significant relationship between inflammation and presence of any postoperative complications, number of daily stools, nighttime stooling, soiling, or stool-altering medication usage.

Conclusion

Acute histologic inflammatory activity at the rectal margin is not associated with increased rates of postoperative complications following IPAA creation in children, nor with poorer continence outcomes following ileostomy closure.

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Keywords : Ulcerative colitis, Ileal pouch anal anastomosis, J-pouch, Geboes score, Total proctocolectomy

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Introduction

Materials and methods

Patients

Surgical technique

Histologic grading of rectal margin

Statistical analysis

Results

Patient demographics and surgical information

Complications

Stooling

Multivariate analysis

Discussion

Conclusions

Esportazione

Vol 219 - N° 4

P. 592-597 - aprile 2020 Ritorno al numero

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Acute histologic inflammatory activity and postoperative outcomes in pediatric patients with ulcerative colitis - 09/04/20

Abstract

Background

Methods

Results

Conclusion

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