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Background: Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with chronic ulcerative colitis (CUC). In the pediatric population, short-term outcomes of IPAA are excellent but long-term data limited. The purpose of this study is to report long-term functional and quality of life outcomes of IPAA in pediatric patients., Methods: Functional outcomes and quality of life (QoL) following IPAA in patients ≤ 18 years of age were prospectively assessed by survey over a 30 year period. Preoperative information, chronic pouchitis and pouch loss were retrospectively reviewed., Results: Over 30 years, 202 children with CUC underwent IPAA. Questionnaires were returned by 87% and median (range) survey follow-up was 181.5 (7.8-378.5) months. Postoperative day and night-time stool frequency did not increase over time though incontinence increased slightly. Quality of life (QoL) was generally excellent and stable over time. Crohn's disease (CD) was diagnosed in 33 (16%) patients during the follow-up period. Chronic pouchitis occurred in 22 patients and pouch failure in 13 patients. Kaplan Meier estimates of pouch survival at 20 years were 61% for patients with CD and 92% for CUC., Conclusions: Ileal pouch-anal anastomosis has long-term durability as a cure for pediatric chronic ulcerative colitis, with most patients reporting stable bowel function and QoL. Chronic pouchitis and pouch failure affect a minority of patients and require further study., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Although single-incision laparoscopic (SIL) ileal pouch-anal anastomosis (IPAA) has been shown to be feasible and safe, outcomes have not been compared with the standard laparoscopic-assisted (LA) procedures. The purpose of this study was to compare the two techniques in children with chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP)., Subjects and Methods: Children ≤ 18 years of age who underwent SIL and LA IPAA between 2000 and 2013 at our institution were identified. Patient information was obtained retrospectively from patients' medical records and compared between approaches. RESULTS for operative time and postoperative length of stay were stratified by number of stages (one, two, or three), and postoperative complications were stratified by diagnosis (CUC or FAP)., Results: Children who underwent SIL IPAA (n=19) and LA IPAA (n=62) were not significantly different in age, gender, diagnosis, anti-tumor necrosis factor-α antibody use, staged approach, and stapled versus mucosectomy with hand-sewn anastomosis. SIL and LA IPAA had equivalent operative times for two- and three-stage procedures, but operative time for one-stage procedures was shorter with SIL (308 versus 355 minutes; P<.001). Median length of stay was shorter following SIL for all patients (4 versus 7 days; P<.001) and, specifically, for two-stage patients (4 versus 6 days; P=.009). There were no significant differences in complications between SIL and LA., Conclusions: SIL IPAA is a safe alternative to LA IPAA for children with CUC or FAP and may reduce postoperative length of stay without affecting short-term postoperative morbidity. Additional studies are needed to determine if there are long-term benefits.

Purpose: Children with chronic ulcerative colitis (CUC) are at increased risk for venous thromboembolism, especially after colectomy procedures. We aim to review our patients with CUC who underwent a colectomy and suffered intra-abdominal thrombosis; moreover we wanted to define thrombotic incidence and outcomes, Methods: In this is IRB approved retrospective study, we reviewed our patients who underwent colectomy for CUC from January 1999 to December 2011 for development of intra-abdominal thrombosis., Results: Of 366 patients with CUC who underwent colectomy, 15 (4%) were diagnosed with a venous thromboembolism. All patients presented with acute abdominal pain. The locations of thrombus formation varied: 13 (87%) developed thrombi in the portal vein, 4 (27%) in the splenic vein, 2 (13%) in the superior mesenteric vein, 1 (7%) in the hepatic vein, and 1 (7%) in the hepatic artery. The mean number of post-operative days at diagnosis of thrombus was 38.7 days (range 3-180 days). Fourteen patients (93%) underwent anticoagulation for treatment. The mean number of days of anticoagulant therapy until documented resolution of thrombus on imaging was 96.3 days (range 14-364 days). All thrombi resolved with therapy. There was no mortality during follow-up., Conclusions: Four percent of our pediatric patients with chronic ulcerative colitis who underwent colectomy developed symptomatic intra-abdominal venous thromboembolism. 3 to 6 months of anticoagulant therapy is adequate treatment in almost all patients. Practitioners should have a high index of suspicion for intra-abdominal venous thrombus when these patients complain of abdominal pain postoperatively. Based on our experience, prophylactic anticoagulation should be strongly considered peri-operatively in this population., (© 2014.)

Background: Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is a common surgical approach to chronic ulcerative colitis (CUC). Preoperative use of Infliximab (IFX) has raised concern of increased postoperative complications. We sought to compare outcomes of pediatric patients (≤ 18 years) who were treated with IFX before IPAA to those who did not., Methods: Patients (≤ 18 years of age) who underwent IPAA from 2003 to 2008 for CUC were included, and their records were retrospectively reviewed for preoperative medications, operative technique, and 1-year postoperative complications (leak, wound infection, small bowel obstruction, pouchitis). Subjects were divided into 2 groups--those who received IFX preoperatively and those who did not., Results: Eleven patients received IFX preoperatively, and 27 children did not. All complications following IPAA were more frequent in the IFX group compared to controls (55% vs 26%). Small bowel obstruction was significantly higher in the IFX group (55% vs 7%). Long-term complications occurred in 64% of the IFX group and 61% of the controls., Conclusion: Children that were treated with IFX prior to IPAA suffered twice as many postoperative complications. Long-term outcomes are similar. Currently, we recommend colectomy with end ileostomy for patients that receive IFX within 8 weeks of colectomy for CUC., (Copyright © 2012 Elsevier Inc. All rights reserved.)