Pediatric patients with inflammatory bowel disease who underwent restorative proctocolectomy with ileal pouch-anal anastomosis had higher rates of pouch complications after surgery compared with adults, but had comparable long-term pouch retention, according to study data.
Researchers conducted a retrospective study to compare outcomes of pediatric and adult patients after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) who were followed for a mean of 10.3 years at the Cleveland Clinic’s Pouch Center between 2002 and 2011. Patients were stratified by age at surgery (aged less than 18 years or aged older than 18 years).
Compared with 1,135 adult patients (55.7% men), the 104 pediatric patients (51% male) were much younger at diagnosis (mean age, 9 years vs. 27 years; P<.001) and at surgery (mean age, 13.4 years vs. 37.4 years; P<.001), and time from diagnosis to colectomy was shorter (P<.001). Ulcerative colitis was the indication for colectomy in 99% of the pediatric group compared with 86.1% of adults (P<.001), and postoperative use of anti-tumor necrosis factor (anti-TNF) agents also was greater in the pediatric group (P=.005).
Compared with 13.5% of adults, 26% of pediatric patients were hospitalized for pouch-related complications (P=.001), including Crohn’s disease (CD) of the pouch (4.1% vs. 11.5%; P=.002). Adults had fewer procedure-related complications (13.3% vs. 20.2%; P=.052).
Risk factors associated with pouch failure included anti-TNF use before (P=.032) and after surgery (P=.002), CD of the pouch (P=.005), procedure-related complications and pouch-associated hospitalization after surgery (both P<.001).There was a numerically smaller proportion of pouch failures among adults (7.4% vs. 11.5%; P=.13), but being a pediatric patient was not associated with increased incidence of pouch failure (HR=0.61; 95% CI, 0.32-1.16).
“Patients with an ileal pouch constructed at a pediatric age tended to have a higher rate of postoperative pouch procedure-related complications,” the researchers concluded. “However, the long-term pouch retention rate was comparable for pediatric and adult patients after IPAA. The data support the consideration of IPAA in pediatric patients.”
Disclosure: The researchers report no relevant financial disclosures.