Restorative proctocolectomy is the treatment of choice for pediatric patients with refractory colitis.
It is also the treatment for inherited polyposis syndromes, and some with colonic aganglionosis.
Evidence concerning the optimal method of reconstruction is, however, sparse.
Dr Paris Tekkis and colleagues from England evaluated studies comparing outcomes from ileal pouch-anal anastomosis, and straight ileoanal anastomosis.
The research team searching Medline, Ovid, and Embase.
The team selected suitable studies and extracted data for meta-analysis.
|Adverse events were similar between the pouch procedures|
|Journal of Pediatric Surgery|
Of the13 studies identified by literature search, 5 satisfied the inclusion criteria.
The studies comprised a total of 306 patients, 86 of whom underwent straight ileoanal anastomosis, and the remainder, ileal pouch-anal anastomosis.
The team found that pouch failure was more common in the straight ileoanal anastomosis group, as were abdominal salvage procedures.
The researchers observed that short-term adverse events were similar between the 2 groups.
The team noted that perianal sepsis occurred more frequently with straight ileoanal anastomosis.
Bowel frequency was lower in the ileal pouch-anal anastomosis patients, although few studies presented functional data in a comparable form.
Dr Tekkis' concludes, “There are few good-quality studies that compare the outcomes from straight ileoanal anastomosis and ileal pouch-anal anastomosis.”
“Caution should be exercised in the generalization of the results of this meta-analysis.”
“This study suggests that pouch procedures are favorable in terms of reconstruction survival and functional outcome.”