Pediatric chronic ulcerative colitis: does infliximab increase post–ileal pouch anal anastomosis complications?

• Published in: Journal of pediatric surgery Vol. 47; no. 1; pp. 199 - 203
• Main Authors: Kennedy, Raelene, Potter, D. Dean, Moir, Christopher, Zarroug, Abdalla E., Faubion, William, Tung, Jeanne
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2012
• Subjects: Anastomosis, Surgical; Anti-Inflammatory Agents - adverse effects; Antibodies, Monoclonal - adverse effects; Child; Chronic Disease; Chronic ulcerative colitis; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - surgery; Colonic Pouches; Female; Humans; Ileum - surgery; Infliximab; IPAA (ileal anal pouch anastomosis); Male; Pediatrics; Postoperative Complications - chemically induced; Postoperative Complications - epidemiology; Retrospective Studies; Surgery; Infliximab; IPAA (ileal anal pouch anastomosis); Chronic ulcerative colitis
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2011.10.042

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. 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. 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. 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.