Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

Irina Oltean; Nicole Travis; Manvinder Kaur; Viviane Grandpierre; Lamia Hayawi; Anne Tsampalieros; Ahmed Nasr

doi:10.1136/wjps-2021-000354

Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

World J Pediatr Surg. 2022 Feb 8;5(2):e000354. doi: 10.1136/wjps-2021-000354. eCollection 2022.

Authors

Irina Oltean¹, Nicole Travis¹, Manvinder Kaur¹, Viviane Grandpierre¹, Lamia Hayawi², Anne Tsampalieros², Ahmed Nasr^{1

3}

Affiliations

¹ Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
² Children's Hospital of Eastern Ontario Research Institute, Clinical Research Unit, Ottawa, Ontario, Canada.
³ University of Ottawa, Ottawa, Ontario, Canada.

Abstract

Background: The efficacy of performing a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting ileostomy in children with inflammatory bowel disease has been a longstanding debate. A systematic review and meta-analysis is presented comparing the occurrence of postoperative complications in children who underwent either the pouch-anal anastomosis (IPAA) with ileostomy (diverted) versus the undiverted procedure.

Methods: Records were sourced from CINAHL, CENTRAL, EMBASE and MEDLINE databases. Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and compared postoperative complications in pediatric patients diagnosed with inflammatory diseases aged less than 18 years who underwent J-pouch with ileostomy versus without ileostomy. The primary outcome was the occurrence of postoperative leaks, and the secondary outcomes were presence of postoperative small bowel obstruction (SBO), pouchitis, stricture and fistula complications. A random-effects meta-analysis was used.

Results: Twenty-three observational studies in the systematic review were included with 658 patients (83% diverted, 17% undiverted). Pooled estimates showed no difference in occurrence of leaks in children who underwent J-pouch/IPAA with ileostomy versus without (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.17 to 1.64, I²=16%). There was no difference in the occurrence of SBO, pouchitis or strictures in children who underwent J-pouch/IPAA with ileostomy versus without (SBO: OR 2.27, 95% CI 0.52 to 9.92, I²=0%, pouchitis: OR 1.76, 95% CI 0.95 to 3.24, I²=0%, strictures: OR 2.72, 95% CI 0.44 to 16.69, I²=66%).

Conclusion: The meta-analysis did not find differences in the occurrence of complications in pediatric patients who underwent the IPAA with ileostomy procedure versus without ileostomy.

Keywords: adolescent health; education; evidence-based medicine; medical; statistics.

Publication types

Review