Journal article
Surgical Management of Ulcerative Colitis in Children and Adolescents: A Systematic Review from the APSA Outcomes and Evidence-Based Practice Committee
Journal of pediatric surgery, v 58(10), pp 1861-1872
01 Oct 2023
PMID: 36941170
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
The incidence of ulcerative colitis (UC) is increasing. Roughly 20% of all patients with UC are diagnosed in childhood, and children typically present with more severe disease. Approximately 40% will undergo total colectomy within ten years of diagnosis. The objective of this study is to assess the available evidence regarding the surgical management of pediatric UC as determined by the consensus agreement of the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee (APSA OEBP).
Through an iterative process, the membership of the APSA OEBP developed five a priori questions focused on surgical decision-making for children with UC. Questions focused on surgical timing, reconstruction, use of minimally invasive techniques, need for diversion, and risks to fertility and sexual function. A systematic review was conducted, and articles were selected for review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of Bias was assessed using Methodological Index for Non-Randomized Studies (MINORS) criteria. The Oxford Levels of Evidence and Grades of Recommendation were utilized.
A total of 69 studies were included for analysis. Most manuscripts contain level 3 or 4 evidence from single-center retrospective reports, leading to a grade D recommendation. MINORS assessment revealed a high risk of bias in most studies. J-pouch reconstruction may result in fewer daily stools than straight ileoanal anastomosis. There are no differences in complications based on the type of reconstruction. The timing of surgery should be individualized to patients and does not affect complications. Immunosuppressants do not appear to increase surgical site infection rates. Laparoscopic approaches result in longer operative times but shorter lengths of stay and fewer small bowel obstructions. Overall, complications are not different using an open or minimally invasive approach.
There is currently low-level evidence related to certain aspects of surgical management for UC, including timing, reconstruction type, use of minimally invasive techniques, need for diversion, and risks to fertility and sexual function. Multicenter, prospective studies are recommended to better answer these questions and ensure the best evidence-based care for our patients.
Level of evidence III.
Systematic review.
Metrics
Details
- Title
- Surgical Management of Ulcerative Colitis in Children and Adolescents: A Systematic Review from the APSA Outcomes and Evidence-Based Practice Committee
- Creators
- Rebecca M. Rentea - University of Missouri–Kansas CityElizabeth Renaud - Hasbro Children's HospitalRobert Ricca - Prisma HealthChristopher Derderian - University of Colorado DenverBrian Englum - University of Maryland, BaltimoreAkemi Kawaguchi - Memorial HermannKatherine Gonzalez - St. Luke's Children's HospitalK. Elizabeth Speck - C. S. Mott Children's HospitalGustavo Villalona - Division of Pediatric Surgery, Nemours Jacksonville, FL, USAAfif Kulaylat - Penn State Milton S. Hershey Medical CenterDerek Wakeman - University of RochesterYasmine Yousef - Montreal Children's HospitalKristy Rialon - Baylor College of MedicineSig Somme - Children's Hospital ColoradoDonald Lucas - Naval Medical Center San DiegoTamar Levene - Joe DiMaggio Children's HospitalHenry Chang - Johns Hopkins All Children's HospitalJoanne Baerg - Presbyterian Healthcare ServicesShannon Acker - University of Colorado DenverJeremy Fisher - University Surgical AssociatesLorraine I. Kelley-Quon - University of Southern CaliforniaRobert Baird - British Columbia Children's HospitalAlana L. Beres - St. Christopher's Hospital for ChildrenAPSA Outcomes and Evidence-Based Practice Committee
- Publication Details
- Journal of pediatric surgery, v 58(10), pp 1861-1872
- Publisher
- Elsevier
- Number of pages
- 12
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:001080112600001
- Scopus ID
- 2-s2.0-85150289756
- Other Identifier
- 991021969475304721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Pediatrics
- Surgery