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Transanal ileal pouch anal anastomosis for ulcerative colitis in children and adults: a systematic review and meta-analysis

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Abstract

Purpose

The incidence of pediatric onset ulcerative colitis (UC) is increasing, with increasing rate of children eventually requiring surgical treatment. Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment. Although transanal IPAA (ta-IPAA) is becoming widely accepted for adult UC patients, data regarding this procedure in children are scarce. Nevertheless, some adult publications also include patients under 18 years old. This systematic review and meta-analysis aimed to summarize surgical and functional outcomes following ta-IPAA, and extract conclusion regarding pediatric UC patients.

Methods

PubMed, Cochrane Library databases, Embase, Web of science and Google Scholar databases were searched, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines. The final search was updated in April 2022. Four comparative cohorts (n = 868) and 11 non-comparative case series (n = 241) were included. Six reports included children. Anastomotic leak, complications, operative time, conversion rate, length of stay and functional outcomes were examined.

Results

A total of 1103 patients, ranging 9–79 years were included in this review. We found no difference in risk for anastomotic leak (OR 1.36, 95% CI 0.46–4.06), minor and major complications (OR 0.92, 95% CI 0.48–1.76 and OR 0.78 95% CI 0.36–1.69, respectively) comparing ta-IPAA to transabdominal IPAA. Short- and long-term follow-up showed satisfying functional outcomes and quality of life.

Conclusions

Our review suggests that ta-IPAA is not inferior to transabdominal IPAA. Implementation of this method in children is technically feasible due to familiarity with the dissection plane. Long-term functional outcomes and quality of life are paramount in the pediatric population and should be particularly investigated. Multicenter prospective studies are required to investigate pediatric UC patients undergoing ta-IPAA.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann st, 6423906, Tel Aviv, Israel

    Audelia Eshel Fuhrer, Haguy Kammar & Igor Sukhotnik

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Audelia Eshel Fuhrer, Jacky Herzlich & Igor Sukhotnik

  3. Department of Pediatrics, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Jacky Herzlich

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All the authors agreed with the content and gave explicit consent to submit this work. 1) All authors whose names appear on the submission made substantial contributions to the conception and design of the work; the acquisition (E.F.A, K.H , H.J, S.I), analysis (E.F.A, K.H), and interpretation of data (E.F.A, K.H , H.J, S.I). 2) E.F.A, S.I and H.J drafted the work and revised it critically for important intellectual content 3) All authors approved the version to be published. 4) All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Eshel Fuhrer, A., Kammar, H., Herzlich, J. et al. Transanal ileal pouch anal anastomosis for ulcerative colitis in children and adults: a systematic review and meta-analysis. Pediatr Surg Int 38, 1671–1680 (2022). https://doi.org/10.1007/s00383-022-05222-y

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