Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the gold standard surgical treatment for ulcerative colitis (UC) and familial adenomatous polyposis (FAP) in adults, demonstrating good long-term functional results. While increasingly adopted in pediatric surgery for UC, FAP, and total colonic aganglionosis, postoperative functional outcomes in children require further evaluation to optimize management strategies.
Purpose:
To assess functional outcomes in pediatric patients after IPAA, analyze changes at 1 and 3 years after stoma closure, and identify postoperative functional outcomes affecting quality of life.
Methods:
The study included 17 out of 25 patients with FAP who underwent IPAA. Functional outcomes were evaluated using the Pouch Functional Score, with 13 patients assessed longitudinally at 1 and 3 years post-stoma closure. Parameters analyzed included stool frequency, daytime/nighttime fecal incontinence, pad usage, perianal dermatitis, tenesmus, and physical activity levels.
Results:
Mean daily stool frequency was 5.5±1.4, with nighttime incontinence (30%) more common than daytime (5%). Pad use was reported by 18% of patients, while perianal dermatitis affected 18%. Longitudinal analysis showed stable stool frequency (median 5/day at both 1 and 3 years, p=0.59). Nighttime incontinence remained prevalent (45% at 1 year, 36% at 3 years, p>0.9), though pad use decreased (27% to 9%, p=0.6). Perianal dermatitis showed clinically meaningful improvement (from 36% to 18%, p=0.7), but the difference did not reach statistical significance. Tenesmus (18%) and physical activity (36%) showed no significant changes.
Conclusion:
IPAA provides stable long-term functional outcomes in pediatric patients, with consistent stool frequency and physical activity. However, nighttime fecal incontinence persists as a significant challenge. While some complications (pad use, dermatitis) improve over time, further refinement of postoperative management is needed to enhance patients' quality of life.
Keywords: pediatric surgery, familial adenomatous polyposis, ilial pouch-anal anastamosis
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