Available online 28 March 2024, 151405

Ileal pouch-anal anastomosis (IPAA) is the procedure of choice for reconstruction after total proctocolectomy in pediatric patients with ulcerative colitis. 30-60% of patients undergoing IPAA will experience a postoperative complication. The primary objective of this article is to address the most common complications specific to IPAA in the pediatric population and provide an up-to-date review of their presentation, risk factors, workup, and management. We also share our preferred approaches to management and prevention of complications, where relevant. We intend to provide a concise review on the topic aimed at pediatric surgeons and healthcare providers involved in the care of this population with the goal of contributing to improved outcomes and patient quality of life.

Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice to restore continence in patients with refractory ulcerative colitis (UC) after proctocolectomy. Crohn's disease (CD) remains controversial as a relative contraindication. Restorative proctocolectomy with IPAA can be performed in one, two, or three stages – colectomy with end ileostomy, completion proctectomy with IPAA and diverting loop ileostomy, then ileostomy takedown. Utilization of this diverting loop ileostomy in the

Leak is an early complication inherent to any intestinal anastomosis, including IPAA. Predisposing factors include steroid use, ulcerative colitis, BMI greater than 25, ASA score greater than 2, disease course of greater than five years, and anti-TNF therapy.12,13 Most leaks occur at the pouch-anal anastomosis, followed by the tip of the “J” and the suture line of the pouch itself, with anastomotic leaks occurring in up to 17.1% of IPAA procedures.12,13 A leak may precipitate abscess, fistula,

Stooling function plays an important role in patients’ quality of life after IPAA. Stooling frequency generally improves rapidly over the first six months postoperatively as the pouch stretches and continues to improve for the first year.62 The pediatric population undergoing IPAA will ultimately have a median of five to six daytime stools and one to two nighttime stools with a daytime fecal incontinence (FI) rate of 18% and a nighttime FI rate of 29%.63,64 Prevention of these complications

While ileo-anal pouch anastomosis is a superior operation for restoration of continuity in pediatric patients who have undergone total proctocolectomy for ulcerative colitis, it is important to be familiar with its limitations. Complications related to this procedure are prevalent, with 30-60% of patients having at least one postoperatively. This procedure also has long-term effects on a patient's diet, bowel habits, sexual function, fertility, and quality of life. Up-to-date knowledge of these

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