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KMID : 1152420180240020086
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Advances in Pediatric Surgery
2018 Volume.24 No. 2 p.86 ~ p.93
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Long-Term Outcome of Patients Undergoing Total Proctocolectomy with Ileal Pouch-Anal Anastomosis in Childhood
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Sim Yoon-Jung
Oh Chae-Youn
Youn Joong-Kee
Kim Soo-Hong
Park Kyu-Joo
Jeong Seung-Yong
Jung Sung-Eun
Park Kwi-Won
Kim Hyun-Young
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Abstract
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Purpose: Total proctocolectomy with ileal pouch-anal anastomosis (T-IPAA) in childhood is a surgical procedure mainly applied to familial adenomatous polyposis (FAP) or ulcerative colitis (UC), but it can be applied to non-FAP/non-UC disease (NFNU). Studies regarding the role of T-IPAA who underwent the operation in childhood, especially in terms of long-term gastrointestinal function, complications, and quality of life (QOL) are limited. The aim of this study was to evaluate the characteristics of patients receiving T-IPAA and to compare their bowel function outcomes and QOL.
Methods: Patients aged ≤18 years at the time of T-IPAA were included. Their medical records were retrospectively reviewed. Krickenbeck classification, Cleveland Clinic Incontinence (CCI) score, 36-item Short-form Health Survey Questionnaire, and Gastrointestinal Quality of Life Index were used for the evaluation of bowel function and QOL. The median follow-up period was 9.8 years.
Results: Of the 25 patients, 9 had FAP, 9 had UC, and 7 had NFNU. NFNU include 3 of Hirschsprung disease, 2 of intestinal neuronal dysplasia, and 2 of imperforate anus. The median age at T-IPAA was 17.8, 14.2, and 9.3 years for FAP, UC, and NFNU, respectively (p=0.001). Bowel function was satisfactory in terms of voluntary bowel movement (VBM), soiling, and constipation. VBM and constipation were not different between the groups, but soiling was most in NFNU (100%, p=0.047). However, QOL was best in the NFNU group in surveys (p=0.034 and 0.004, respectively).
Conclusion: T-IPAA could be safely applied not only for FAP and UC but also for other diseases in selective cases, with caution.
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KEYWORD
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Ileoanal pouches, Familial adenomatous polyposis, Ulcerative colitis, Pediatrics, Hirschsprung disease
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