Quality of life after Colectomy and Ileo-Jpouch-anal anastomosis in paediatric patients with Ulcerative Colitis

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Surgery is required in cases of severe acute colitis, massive hemorrhage, toxic megacolon, and perforation; in such cases colectomy and JpouchIleoanal anastomosis (IPAA) are performed. The aim of this study was to evaluate functional outcome, and patient satisfaction and Quality of Life (QoL) after surgery. MATERIAL AND METHODS Questionnaires were administered to 24 patients with UC undergoing surgery from 2011 to 2022. RESULTS Mean age at IPAA was 10.8 years. Twenty patients underwent IPAA in 3 operations, 4 patients in 2. All patients underwent laparoscopic surgery. Six months after surgery mean level of satisfaction was 8.7/10, perception of health status was 7.4. Twenty-three patients (95.8%) recommended IPAA. For 20 patients (83.3%) surgery did not cause delay in education, while 14 patients (58.3%) played sport. The lowest number of evacuations was 9.2 per day, the highest 13.3. Seventeen patients (70.8%) had no incontinence and 15 patients (62.5%) were not affected by pouchitis. After 12 months mean satisfaction level raised up to 9.2/10, perception of health status to 8.5. School absences decreased and no other patients showed any delay in education. Seventeen (70.8%) patients played sports. The number of evacuations decreased: the lowest number was 5.1 per day, the highest 7.5. Twenty patients (83.3%) were continent and 12 (50%) did not use antibiotics. CONCLUSION Most patients show a good functional outcome in defecation frequency and continence, which has improved through time, number of pouchitis episodes has increased. Patients appear satisfied after surgery. Level of Evidence : III IBD colon surgery pediatric UC Quality of Life Figures Figure 1 Highlights Ulcerative Colitis (UC) have an increasing incidence in paediatric patients. For this children there is also an increased risk of surgery. Our work suggests that patients have a good functional outcome after surgery which improves through time. Introduction Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) extending to the mucosa and submucosa, from the rectum to possibly involve the entire colon. In 25% of cases, the disease is first diagnosed in childhood, 41% have pancolitis at the time of diagnosis, and more than one-third of cases requires hospitalization. [ 1 – 4 ]. Although most children with UC can be successfully managed with medications, some will require surgical interventions. Literature suggests that childhood-onset disease may have a more severe course, with a 30–40% colectomy rate at the age of ten, as compared with 20% in adults [ 5 ]. Surgery is performed in cases of acute severe or fulminant colitis, massive colorectal hemorrhage, bowel obstruction, toxic megacolon, and perforation [ 2 , 4 , 6 – 8 ]. Proctocolectomy and Ileo-J pouch-anal anastomosis (IPAA) is the gold standard. IPAA was first described in 1978 by Parks and Nicholls and subsequently it was modified through minimally invasive techniques such as the laparoscopic, robotic, and transanal approach (Ta-IPAA) [ 9 , 10 ]. The laparoscopic approach is successful in reducing postoperative hospital stay, surgical site infections, and postoperative pain. [ 9 – 11 ]. Advantages of J-pouch reservoir are maintaining continence and controlling defecation, resulting in improved quality of life. [ 6 , 8 , 11 ]. Studies in adult patients report significant improvement in quality of life (QoL) and health status after colectomy, compared with the preoperative condition. Additional improvement is observed after ostomy closure [ 12 ]. For this reason, IPAA is also referred to as "QoL surgery" [ 13 ]. Disease symptoms and outcomes of surgery impact patients’ perception of body image and their social relationships. There are many long-term studies on QoL in adults, but studies on paediatric patients still lack [ 14 ]. QoL studies give a comprehensive picture of the impact of surgery on daily life. This contributes to patient-focused health care, identification of specific needs, informed decision making, and optimization of support services to enhance the overall QoL of patients and their families. [ 15 , 16 ]. The aim of this study is to detect long-term QoL, including the evaluation of school attendance and sports practice, in paediatric patients undergoing reconstructive surgery for UC. Material and Methods The study was conducted at IRCCS Istituto Giannina Gaslini in Genoa. The study period was from January 2010 to January 2023. All the patients under the age of 18 subjected to IPAA at our Institute were included. Data were collected retrospectively based on outpatient visits. Ethical committee approval was obtained on 18/09/2023, protocol n° 206/2023 - DB id 13137. Data were collected through the evaluation of medical records and follow-up visits during the postoperative period and a questionnaire was administered to patients, based on the study by Wewer Vibeke et al [ 15 ]. The questionnaire is described in detail in Table 1 . Six life domains were considered and the questionnaire examined the patient's QoL 6 months after surgery, after one year and at the time of telephone contact (Table 1 ). At the time of the telephone interview, participants had to recall how they were feeling at the time, which could represent a reliability bias. Table 1 Questionnaire Questionnaire Satisfaction with the result of surgery 1–10 Perception of health status 1–10 Number of School or Work absence 1–5 days Delayed education Yes / No Need to discontinued sport Yes / No Advise other patients to have the same operation performed Yes / No Number of bowel movements during the day 10 Number of bowel movements overnight 5 Stool Consistency Watery / Normal-loose Medication to increase stool consistency Yes / No Ability to discriminate air and stool Yes / No Capacity to empty the pouch Yes / No Ability to defer defecation Yes / No Incontinence of mucus or feces Yes / No Soiling Yes / No Antibiotics for pouchitis Yes / No Number of received treatment 5 Treatment in other hospitals because of problems with the pouch Yes / No Statistical Analysis A descriptive analysis of the entire population was performed. Descriptive statistics were reported in terms of absolute frequencies or percentages for qualitative data, while the mean, median, and range were used to describe quantitative variables. Differences in the frequencies of each variable were assessed by Fisher's exact test when appropriate. A p-value < 0.05 was considered statistically significant. Results Thirty-three patients underwent IPAA in the study period. Two patients received a late diagnosis of CD and were initially treated with IPAA. They were excluded from the study. Thirty-one patients were included. Seven patients were lost at follow-up following adult transition. The questionnaire was submitted to 24 patients. Data about age at diagnosis, at colectomy and reconstructive surgery are reported in Table 2 . Table 2 Patient characteristics Patient characteristics M = 10 F = 14 Mean Min Max Median Age at diagnosis 8,1 1,3 16,8 8,3 Age at Colectomy 10,8 2,2 18,6 12,3 Age at IPAA 10,8 3,3 18,7 12,6 Age at bowel continuity reintegration 10,9 3,4 18,8 12,7 Most patients underwent the surgical pathway in three-stages (20 patients, 83.3%), while 4 patients (16.7%) underwent the two-stage modified procedure. The laparoscopic approach was used for 17 patients (68%), while robotic laparoscopy was used in 7 cases (32%). At the moment of telephone interview, 11 patients had a follow-up 10 years. The outcomes of surgery were considered satisfactory for patients/parents, with a mean score of 8.7/10 in the first six months, raising to 9.2/10 twelve months after surgery. In the first six months, 2 patients (8.3%) gave a grade < 5 / 10 and only one patient did not recommend the intervention to other patients. One year after the reconstructive operation, 100% of patients/parents recommended the intervention. Perception of health status improved in the 12-months follow-up, raising from 7.4/10 to 8.5/10. Critical issues were mainly related to limitations to social life due to frequent bowel movements. Surgery caused delayed education in 4 patients (16.7%) and this record was stable during follow-up. School absences decreased from 1.5 to 0.8 in 5 days. In the first six months, 10 patients (41.7%) discontinued sports, while 12 months after the intervention, 17 patients (70.8%) played sports activities. The mean number of bowel movements during the day and overnight after 6 months were respectively 8.1 (range: 3–18) and 2.7 (range: 1–6), while after 12 months they reduced to 4.7 (range 2–10) bowel movements during the day and 1 (range: 0–3) during the night. The minimum and maximum number of evacuations over 24 hours at follow-up after 6 months was 9.2 (range 3–20) and 13.3 (range 6–22), and after 12 months was 5.1 and 7.5. After 6 months, stool consistency was described predominantly watery (n = 14, 58.4%), while after 12 months all the patients reported normal-loose stools. Twenty- three patients (95.8%) after 6 months and 22 patients (91.2%) after 12 months used medication to increase stool consistency. The ability to discriminate air and stool after 6 and 12 months was present in 18 patients (75%) and 21 patients (87.5%), respectively. The capacity to empty the pouch was 62.5% after 6 months and 79.2% after one year, while the ability to defer defecation increases from 70.8–91.2%. Incontinence of mucus or feces and soiling were present in 7 (29.2%) and in 11 patients (45.8%), respectively, 6 months after surgery; and decreased to 4 patients (16.7%) and 5 patients (20.8%) 12 months after surgery. Antibiotics for pouchitis were used in 9 patients (37.5%) in the first 6 months and in 12 patients (50%) in the first year. Patients received a mean of 1.1 treatments (range1-3) after 6 months and 1.3 (range 0–4) after 12 months; two patients (8.3%) received treatment in other hospitals, for pouch problems, within the first follow-up, while 6 patients (25%) 1 year after surgery. A statistically significant difference (p < 0.05) in the scores between 6 and 12 months after intervention was observed concerning: perception of health status (p = 0.0096), number of bowel movements during the day (p = 0,0001), number of bowel movements during the night (p = 0,0001), minimum number of bowel movements in 24 hours (p = 0,0001), maximum number of bowel movements in 24 hours (p = 0,0001) and stool consistency (p = 0,0004). Five patients had a 2–4 years follow up, 9 patients had a 5–10 years follow-up. Four patients had their last follow-up more than 10 years after surgery. Questionnaire results are shown in Table 3. Table 3. Long term follow up (Group A 2-4 years; Group B 5-10 years; Group C >10 years) Values are mean (range) unless otherwise indicated. Questionnaire Group A 5 patients Group B 10 patients Group C 3 patients Satisfaction with the result of surgery 9,2 (7-10) 9,4 (7-10) 10 Perception of health status 8,6 (7-10) 8,4 (6,5 -10) 7,6 (6-9) Number of School or Work absence 0,1/5 (0-1) 0/5 0,3/5 (0-1) Delayed education Yes : 1 No : 4 Yes : 1 No : 9 Yes : 1 No : 4 Need to discontinued sport Yes : 3 No : 2 Yes : 2 No : 8 Yes : 0 No : 3 Advise other patients to have the same operation performed Yes : 5 No : 0 Yes : 10 No : 0 Yes : 3 No : 0 Number of bowel movements during the day 5,7 (4-10) 5,5 (3-7) 4 (3-5) Number of bowel movements overnight 0,9 (0-3) 0,9 (0-2) 0,3 (0-1) Stool Consistency Watery: 0 Normal-loose: 5 Watery: 1 Normal-loose: 9 Watery: 0 Normal-loose: 3 Medication to increase stool consistency Yes :5 No :0 Yes :8 No :2 Yes : 2 No : 1 Ability to discriminate air and stool Yes : 4 No : 1 Yes : 9 No : 1 Yes : 3 No : 0 Capacity to empty the pouch Yes : 4 No : 1 Yes : 7 No : 3 Yes : 3 No : 0 Ability to defer defecation Yes : 4 No : 1 Yes : 10 No : 0 Yes : 3 No : 0 Incontinence of mucus or feces Yes : 2 No : 3 Yes : 2 No : 8 Yes : 3 No : 0 Soiling Yes 1 No 4 Yes 4 No 6 Yes : 0 No : 3 Antibiotics for pouchitis Yes 3 No 2 Yes 5 No 5 Yes : 1 No : 2 Number of received treatment 2,1 (0-4) 1,5 (0-4) 1,3 (1-3) Treatment in other hospitals because of problems with the pouch Yes : 1 No : 4 Yes : 2 No : 8 Yes : 1 No : 2 Discussion Our study describes the outcome and QoL of pediatric patients with UC undergoing colectomy and IPAA. Difficulties that arise after surgery include: a change in bowel habits, with increased evacuations, risk of incontinence and soiling; the need to take medication to control stool and to treat inflammation of the residual rectum and pouch [ 17 ]. Wewer Vibeke et al. questionnaire was used to assess outcomes and QoL in pediatric patients [ 18 ]. Data collected at 6-month and 12-month follow-up were compared, an improvement in QoL was found in the first year after bowel reintegration. Variation in perceived health status increased comparing follow up 6 and 12 months after surgery, and the data were statistically significant. Satisfaction with surgical outcomes increased after 1 year. In the study previously conducted by Wewer et al. good satisfaction was achieved in 96% of patients, while Durno et al. found optimal functional outcomes in 90% of patients [ 19 ]. Data at the last follow-up were collected in five patients 2–4 years after ileostomy closure, in ten patients 5–10 years after ileostomy closure and three patients after mor than 10 years. These patients showed excellent satisfaction with surgical outcomes. Regarding perceived health status, group of patients with more than 10 years of follow-up gave a score of 7.6/10, lower than the other groups. This difference could be attributed to several factors. First, as patients grow older, they are more aware of difficulties their condition brings in the social context. Even after ileostomy closure, patients continue to take medications to control stool or manage inflammation of the rectum or residual pouch. This may affect the perception of their overall health status. The number of bowel movements has changed significantly within a year. According to the scientific literature, one year is necessary to achieve satisfactory functional results. Twelve months are needed for the vanishing of local response to the surgical trauma, to complete the bowel adaptation, and to give the patient time to get used to the new bowel functions [ 20 – 22 ]. The number of defecations during the day and during the night decreased during the follow-up, also the lowest number of evacuations in 24h decreased. All these data are statistically significant and in line with the results of other previous studies. The study by Wewer et al. describes a mean of 6 evacuations during the day, 1 during the night, with lowest number of evacuations of 3 and a highest number of 10 in 24 h [ 18 ]. Durno et al. reported in their study that 16 patients (84%) aged 11 years or more at time of IPAA and who have had ileoanal continuity restored for at least 30 months had between 3 and 10 bowel movements in 24 h, while 16% had more than 10 [ 19 ]. Also literature related to IPAA on adult confirms mean of 6 bowel movement during 24h, 40 months after surgery [ 23 ]. In patients with follow-up one year after ostomy closure, a reduction in evacuations is observed. These data agree with previously reported studies in which there is a continuous improvement in bowel movements with increasing time. Although the results are not statistically significant, our data show an improvement in pouch function from the first follow-up after 6 months compared with follow up after 1 year. Interestingly, these abilities further improve in patients with extended follow-up. Pellino et al. found that a high percentage of patients (92%) were able to discriminate between air and faeces and that diurnal continence was achieved by 100% of patients [ 22 ]. According to our study data, stool consistency improved significantly between 6 months and one year after surgery and continued to improve over time, although patients had to continue taking medication. Many families reported that quality and quantity of stools varies greatly in relation to diet. This often affects the social life of children, who have to adjust mealtimes. Incontinence decreases over time, but it still remains a problem, especially at night, and in girls it worsens around the time of menstruation. The studies by Wewer et al. and Durno et al. reported a much lower percentage of continent patients (50%), while Sarigold et al. and Rintala et al. had similar results to our study (72–100%) [ 18 , 19 ]. Soiling is more common than incontinence. In the study by Watanabe et al., most patients had never or only rarely experienced soiling (75%) [ 20 ]. In our study we also investigated how IPAA had an impact on patient education. School absences progressively decreased through the time. Only in four patients a delay in education was present, remaining stable throughout the follow-up period. The study by Durno et al. shows that 75% of the children had no restrictions on school activities [ 19 ]. Stopping sport activities was necessary for 10 patients for the first 6 months, but one year after surgery the percentage of patients playing sports increased. These data are similar to those of Wewer et al. in which 30 percent of patients had to give up sports activities [ 18 ]. Durno et al. found that only 10% (3/28) gave up sports due to bowel dysfunction [ 19 ]. Two out of five patients with 2–4 years of follow-up and eight out of ten with 5–10 years of follow-up play sports, while all patients more than 10 years after ostomy closure play sports. These data agree with the study by Polites et al. in which 5 years after surgery, about 50% of patients have no limitations in sports activities, after 10 years about 70% play sports [ 24 ]. In our study, pouchitis has an inverse trend on other data. In fact, the percentage of patients who had at least one episode of pouchitis increases during the first year. Similar results were obtained by Wewer et al. who reported at least one episode of pouchitis in 48% of patients [ 18 ], and the study by Durno et al. in which pouchitis occurred in 44% of cases [ 19 ]. Previous studies on adult patients with UC who underwent IPAA reported that all Qol domains and functional outcome were significantly worse with increasing age [ 25 ]. Zmora et al. suggest that the functional outcomes of pediatric patients undergoing IPAA are better than those of adults. If Qol is perceived by the patients themselves once they become adults, their responses are comparable to those of the general population. Moreover, the results of this group are better than those of UC patients undergoing IPAA as adults [ 26 ]. Conclusions Our results indicate that IPAA in pediatric patients can lead to improvement of bowel symptoms over time. However, incontinence, pouchitis and other functional problems may persist in a non-negligible percentage of patients. It can be suggested that IPAA leads to satisfactory health status and QoL for patients and that these outcomes remain stable even more than 10 years after surgery. Repeating a QoL analysis with adult questionnaires when the same patients are older than 18 years could provide more information about how Qol varies over time. Abbreviations UC = Ulcerative colitis (UC) IBD = Inflammatory Bowel Disease IPAA = Ileo-J pouch-anal anastomosis Ta-IPAA = transanal approach QoL = quality of life Declarations Funding . This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflicts of interest . The authors declare that they have no conflict of interest. Author Contribution Author Contribution Study conception and design: Michela Cing Yu Wong, Giulia Rotondi, Serena Arrigo, Stefano Avanzini, Paolo Gandullia, Girolamo MattioliData acquisition: Giulia Rotondi, Margherita Roso Analysis and data interpretation: Michela Cing Yu Wong, Giulia RotondiDrafting of the manuscript: Michela Cing Yu Wong, Giulia Rotondi, Margherita RosoCritical revision: Michela Cing Yu Wong(*): Modified from the authorship requirements of the J Am Coll Surg Acknowledgement We declare that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.We take full responsibility for the work being reported. It is the original study and has been neither published elsewhere nor submitted for publication. Dott.ssa Giulia RotondiOn behalf of all authors Data Availability data is provided within the manuscript or supplementary information files References Arantes JAV, dos Santos CHM, Delfino BM et al Epidemiological profile and clinical characteristics of patients with intestinal inflammatory disease. (Rio J) 2017 J Coloproctol Vol 37(4):273–278. 10.1016/j.jcol.2017.06.004 Falcone RA, Glen Lewis L, Warner BW et al (2000) Predicting the need for colectomy in pediatric patients with ulcerative colitis, Journal of Gastrointestinal Surgery, Volume 4, Issue 2, Pages 201–206, ISSN 1091-255X, https://doi.org/10.1016/S1091-255X(00)80057 Griffiths AM (2004) Specificities of inflammatory bowel disease in childhood. 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Cite Share Download PDF Status: Published Journal Publication published 17 Aug, 2024 Read the published version in Pediatric Surgery International → Version 1 posted Editorial decision: Revision requested 29 Jul, 2024 Reviews received at journal 28 Jul, 2024 Reviews received at journal 14 Jul, 2024 Reviewers agreed at journal 14 Jul, 2024 Reviewers agreed at journal 14 Jul, 2024 Reviewers agreed at journal 14 Jul, 2024 Reviewers invited by journal 27 May, 2024 Editor assigned by journal 21 May, 2024 Submission checks completed at journal 21 May, 2024 First submitted to journal 20 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4449621","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308665901,"identity":"a6c4949c-5bda-4b1a-8486-307727f586b3","order_by":0,"name":"Michela Cing Yu Wong","email":"","orcid":"","institution":"Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy","correspondingAuthor":false,"prefix":"","firstName":"Michela","middleName":"Cing Yu","lastName":"Wong","suffix":""},{"id":308665902,"identity":"e8e5e701-e0e0-434f-8e04-a280a08f6ce2","order_by":1,"name":"Giulia Rotondi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYDACZgbGAwlQtkRCxQEZBgbGBkJaGMBaeMBazhwA0oyNBPQAtTDAtDC2gbQQsEbencfgwIOae3L27L0HbzycdwfIZW5/gE+L4WGgmoRjxcY8POeSLRK3PQNyCTjMsBmkhS0hsUcix0wicdthYrX8g2mZQ4QWeWagmsQ2mJYGIrQYMLMVHEjsSzDmOXPG2CLh2DMeycOMjTPw2tJ/eOPDH98S5Njbewxv/qi5I8d3vP3BB7y2HMAQYsanHmQLXmePglEwCkbBKAABABdMTw8IXTv5AAAAAElFTkSuQmCC","orcid":"","institution":"Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy","correspondingAuthor":true,"prefix":"","firstName":"Giulia","middleName":"","lastName":"Rotondi","suffix":""},{"id":308665903,"identity":"57193ff8-1830-498c-a8a9-3c5c2a702cfe","order_by":2,"name":"Margherita Roso","email":"","orcid":"","institution":"DINOGMI, University of Genoa, Genoa, Italy","correspondingAuthor":false,"prefix":"","firstName":"Margherita","middleName":"","lastName":"Roso","suffix":""},{"id":308665904,"identity":"e5142781-90b1-4c63-8e19-e3a592bf0384","order_by":3,"name":"Stefano Avanzini","email":"","orcid":"","institution":"Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy","correspondingAuthor":false,"prefix":"","firstName":"Stefano","middleName":"","lastName":"Avanzini","suffix":""},{"id":308665905,"identity":"8e17aa4c-ba43-4164-b837-93ebe67a1304","order_by":4,"name":"Paolo Gandullia","email":"","orcid":"","institution":"Pediatric gastroenterology and endoscopy Department, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy","correspondingAuthor":false,"prefix":"","firstName":"Paolo","middleName":"","lastName":"Gandullia","suffix":""},{"id":308665906,"identity":"68adae0c-ecaf-47d4-9cf9-4c2fbfa319eb","order_by":5,"name":"Serena Arrigo","email":"","orcid":"","institution":"Pediatric gastroenterology and endoscopy Department, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy","correspondingAuthor":false,"prefix":"","firstName":"Serena","middleName":"","lastName":"Arrigo","suffix":""},{"id":308665907,"identity":"1c1f6566-f132-4d24-9801-9d7e9de6b3d4","order_by":6,"name":"Girolamo Mattioli","email":"","orcid":"","institution":"Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy","correspondingAuthor":false,"prefix":"","firstName":"Girolamo","middleName":"","lastName":"Mattioli","suffix":""}],"badges":[],"createdAt":"2024-05-20 14:07:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4449621/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4449621/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00383-024-05824-8","type":"published","date":"2024-08-17T15:57:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57866578,"identity":"fade7570-fe03-4d44-98d2-572643872897","added_by":"auto","created_at":"2024-06-06 15:53:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":100732,"visible":true,"origin":"","legend":"\u003cp\u003eComparison tables between 6-month and 1-year follow-up: the outcomes of surgery were considered satisfactory for patients/parents. Satisfaction with surgical outcomes increased after 1 year (1a, 1b).\u003c/p\u003e\n\u003cp\u003eThe number of bowel movements has changed significantly within a year. One year is necessary to achieve satisfactory functional results (1c).\u003c/p\u003e\n\u003cp\u003eIncontinence, pouchitis and other functional problems may persist in a non-negligible percentage of patients (1d),\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4449621/v1/673a0d90be1e3a636f0a0e76.png"},{"id":63071266,"identity":"7fe03e28-54f7-4ae6-87d9-34c194a8e9e4","added_by":"auto","created_at":"2024-08-22 20:05:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":685887,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4449621/v1/2bae9c44-e668-4c73-bc0d-27c534074ea3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality of life after Colectomy and Ileo-Jpouch-anal anastomosis in paediatric patients with Ulcerative Colitis","fulltext":[{"header":"Highlights","content":"\u003cp\u003eUlcerative Colitis (UC) have an increasing incidence in paediatric patients. For this children there is also an increased risk of surgery. Our work suggests that patients have a good functional outcome after surgery which improves through time.\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eUlcerative colitis (UC) is an inflammatory bowel disease (IBD) extending to the mucosa and submucosa, from the rectum to possibly involve the entire colon. In 25% of cases, the disease is first diagnosed in childhood, 41% have pancolitis at the time of diagnosis, and more than one-third of cases requires hospitalization. [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough most children with UC can be successfully managed with medications, some will require surgical interventions. Literature suggests that childhood-onset disease may have a more severe course, with a 30\u0026ndash;40% colectomy rate at the age of ten, as compared with 20% in adults [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Surgery is performed in cases of acute severe or fulminant colitis, massive colorectal hemorrhage, bowel obstruction, toxic megacolon, and perforation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eProctocolectomy and Ileo-J pouch-anal anastomosis (IPAA) is the gold standard. IPAA was first described in 1978 by Parks and Nicholls and subsequently it was modified through minimally invasive techniques such as the laparoscopic, robotic, and transanal approach (Ta-IPAA) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The laparoscopic approach is successful in reducing postoperative hospital stay, surgical site infections, and postoperative pain. [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdvantages of J-pouch reservoir are maintaining continence and controlling defecation, resulting in improved quality of life. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies in adult patients report significant improvement in quality of life (QoL) and health status after colectomy, compared with the preoperative condition. Additional improvement is observed after ostomy closure [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For this reason, IPAA is also referred to as \"QoL surgery\" [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDisease symptoms and outcomes of surgery impact patients\u0026rsquo; perception of body image and their social relationships. There are many long-term studies on QoL in adults, but studies on paediatric patients still lack [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. QoL studies give a comprehensive picture of the impact of surgery on daily life. This contributes to patient-focused health care, identification of specific needs, informed decision making, and optimization of support services to enhance the overall QoL of patients and their families. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The aim of this study is to detect long-term QoL, including the evaluation of school attendance and sports practice, in paediatric patients undergoing reconstructive surgery for UC.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThe study was conducted at IRCCS Istituto Giannina Gaslini in Genoa. The study period was from January 2010 to January 2023. All the patients under the age of 18 subjected to IPAA at our Institute were included. Data were collected retrospectively based on outpatient visits. Ethical committee approval was obtained on 18/09/2023, protocol n\u0026deg; 206/2023 - DB id 13137.\u003c/p\u003e \u003cp\u003eData were collected through the evaluation of medical records and follow-up visits during the postoperative period and a questionnaire was administered to patients, based on the study by Wewer Vibeke et al [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The questionnaire is described in detail in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Six life domains were considered and the questionnaire examined the patient's QoL 6 months after surgery, after one year and at the time of telephone contact (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). At the time of the telephone interview, participants had to recall how they were feeling at the time, which could represent a reliability bias.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestionnaire\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestionnaire\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSatisfaction with the result of surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1\u0026ndash;10\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception of health status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1\u0026ndash;10\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of School or Work absence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1\u0026ndash;5 days\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelayed education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeed to discontinued sport\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdvise other patients to have the same operation performed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of bowel movements during the day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;5\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e5\u0026ndash;10\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;10\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of bowel movements overnight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;5\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;5\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStool Consistency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eWatery / Normal-loose\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication to increase stool consistency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbility to discriminate air and stool\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCapacity to empty the pouch\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbility to defer defecation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncontinence of mucus or feces\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSoiling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntibiotics for pouchitis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of received treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;5\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;5\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment in other hospitals because of problems with the pouch\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eYes / No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eA descriptive analysis of the entire population was performed. Descriptive statistics were reported in terms of absolute frequencies or percentages for qualitative data, while the mean, median, and range were used to describe quantitative variables. Differences in the frequencies of each variable were assessed by Fisher's exact test when appropriate. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThirty-three patients underwent IPAA in the study period. Two patients received a late diagnosis of CD and were initially treated with IPAA. They were excluded from the study.\u003c/p\u003e\n\u003cp\u003eThirty-one patients were included. Seven patients were lost at follow-up following adult transition. The questionnaire was submitted to 24 patients. Data about age at diagnosis, at colectomy and reconstructive surgery are reported in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePatient characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePatient characteristics\u003c/p\u003e\n \u003cp\u003eM\u0026thinsp;=\u0026thinsp;10 F\u0026thinsp;=\u0026thinsp;14\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMin\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMax\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at Colectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at IPAA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at bowel continuity reintegration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eMost patients underwent the surgical pathway in three-stages (20 patients, 83.3%), while 4 patients (16.7%) underwent the two-stage modified procedure. The laparoscopic approach was used for 17 patients (68%), while robotic laparoscopy was used in 7 cases (32%). At the moment of telephone interview, 11 patients had a follow-up \u0026lt;\u0026thinsp;5 years, 9 patients between 5 and 10 years, and 4 patients\u0026thinsp;\u0026gt;\u0026thinsp;10 years.\u003c/p\u003e\n\u003cp\u003eThe outcomes of surgery were considered satisfactory for patients/parents, with a mean score of 8.7/10 in the first six months, raising to 9.2/10 twelve months after surgery. In the first six months, 2 patients (8.3%) gave a grade\u0026thinsp;\u0026lt;\u0026thinsp;5\u003cstrong\u003e/\u003c/strong\u003e10 and only one patient did not recommend the intervention to other patients. One year after the reconstructive operation, 100% of patients/parents recommended the intervention.\u003c/p\u003e\n\u003cp\u003ePerception of health status improved in the 12-months follow-up, raising from 7.4/10 to 8.5/10. Critical issues were mainly related to limitations to social life due to frequent bowel movements.\u003c/p\u003e\n\u003cp\u003eSurgery caused delayed education in 4 patients (16.7%) and this record was stable during follow-up. School absences decreased from 1.5 to 0.8 in 5 days. In the first six months, 10 patients (41.7%) discontinued sports, while 12 months after the intervention, 17 patients (70.8%) played sports activities.\u003c/p\u003e\n\u003cp\u003eThe mean number of bowel movements during the day and overnight after 6 months were respectively 8.1 (range: 3\u0026ndash;18) and 2.7 (range: 1\u0026ndash;6), while after 12 months they reduced to 4.7 (range 2\u0026ndash;10) bowel movements during the day and 1 (range: 0\u0026ndash;3) during the night. The minimum and maximum number of evacuations over 24 hours at follow-up after 6 months was 9.2 (range 3\u0026ndash;20) and 13.3 (range 6\u0026ndash;22), and after 12 months was 5.1 and 7.5.\u003c/p\u003e\n\u003cp\u003eAfter 6 months, stool consistency was described predominantly watery (n\u0026thinsp;=\u0026thinsp;14, 58.4%), while after 12 months all the patients reported normal-loose stools. Twenty- three patients (95.8%) after 6 months and 22 patients (91.2%) after 12 months used medication to increase stool consistency.\u003c/p\u003e\n\u003cp\u003eThe ability to discriminate air and stool after 6 and 12 months was present in 18 patients (75%) and 21 patients (87.5%), respectively. The capacity to empty the pouch was 62.5% after 6 months and 79.2% after one year, while the ability to defer defecation increases from 70.8\u0026ndash;91.2%. Incontinence of mucus or feces and soiling were present in 7 (29.2%) and in 11 patients (45.8%), respectively, 6 months after surgery; and decreased to 4 patients (16.7%) and 5 patients (20.8%) 12 months after surgery.\u003c/p\u003e\n\u003cp\u003eAntibiotics for pouchitis were used in 9 patients (37.5%) in the first 6 months and in 12 patients (50%) in the first year. Patients received a mean of 1.1 treatments (range1-3) after 6 months and 1.3 (range 0\u0026ndash;4) after 12 months; two patients (8.3%) received treatment in other hospitals, for pouch problems, within the first follow-up, while 6 patients (25%) 1 year after surgery.\u003c/p\u003e\n\u003cp\u003eA statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the scores between 6 and 12 months after intervention was observed concerning: perception of health status (p\u0026thinsp;=\u0026thinsp;0.0096), number of bowel movements during the day (p\u0026thinsp;=\u0026thinsp;0,0001), number of bowel movements during the night (p\u0026thinsp;=\u0026thinsp;0,0001), minimum number of bowel movements in 24 hours (p\u0026thinsp;=\u0026thinsp;0,0001), maximum number of bowel movements in 24 hours (p\u0026thinsp;=\u0026thinsp;0,0001) and stool consistency (p\u0026thinsp;=\u0026thinsp;0,0004).\u003c/p\u003e\n\u003cp\u003eFive patients had a 2\u0026ndash;4 years follow up, 9 patients had a 5\u0026ndash;10 years follow-up. Four patients had their last follow-up more than 10 years after surgery. Questionnaire results are shown in Table\u0026nbsp;3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. \u0026nbsp;Long term follow up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(Group A 2-4 years; Group B 5-10 years; Group C \u0026gt;10 years)\u003cbr\u003e\u003cem\u003eValues are mean (range) unless otherwise indicated.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"664\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\" valign=\"top\"\u003e\n \u003cp\u003eQuestionnaire\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e5 patients\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e10 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e3 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\" valign=\"top\"\u003e\n \u003cp\u003eSatisfaction with the result of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003e9,2 (7-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e9,4 (7-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\" valign=\"top\"\u003e\n \u003cp\u003ePerception of health status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003e8,6 (7-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e8,4 (6,5 -10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e7,6 (6-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of School or Work absence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0,1/5 (0-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0,3/5 (0-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eDelayed education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 1\u003c/p\u003e\n \u003cp\u003eNo : 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 1\u003c/p\u003e\n \u003cp\u003eNo : 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 1\u003c/p\u003e\n \u003cp\u003eNo : 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eNeed to discontinued sport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 3\u003c/p\u003e\n \u003cp\u003eNo : 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 2\u003c/p\u003e\n \u003cp\u003eNo : 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 0\u003c/p\u003e\n \u003cp\u003eNo : 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eAdvise other patients to have the same operation performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 5\u003c/p\u003e\n \u003cp\u003eNo : 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 10\u003c/p\u003e\n \u003cp\u003eNo : 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 3\u003c/p\u003e\n \u003cp\u003eNo : 0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eNumber of bowel movements during the day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003e5,7 (4-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e5,5 (3-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eNumber of bowel movements overnight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003e0,9 (0-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e0,9 (0-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e0,3 (0-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eStool Consistency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eWatery: 0\u003cbr\u003e\u0026nbsp;Normal-loose: 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eWatery: 1\u003c/p\u003e\n \u003cp\u003eNormal-loose: 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eWatery: 0\u0026nbsp;\u003cbr\u003e\u0026nbsp;Normal-loose: 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eMedication to increase stool consistency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes :5\u003c/p\u003e\n \u003cp\u003eNo :0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes :8\u003c/p\u003e\n \u003cp\u003eNo :2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 2\u003c/p\u003e\n \u003cp\u003eNo : 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eAbility to discriminate air and stool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 4\u003c/p\u003e\n \u003cp\u003eNo : 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 9\u003c/p\u003e\n \u003cp\u003eNo : 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 3\u003c/p\u003e\n \u003cp\u003eNo : 0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eCapacity to empty the pouch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 4\u003c/p\u003e\n \u003cp\u003eNo : 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 7\u003c/p\u003e\n \u003cp\u003eNo : 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 3\u003c/p\u003e\n \u003cp\u003eNo : 0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eAbility to defer defecation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 4\u003cbr\u003e\u0026nbsp;No : 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 10\u003cbr\u003e\u0026nbsp;No : 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 3\u003cbr\u003e\u0026nbsp;No : 0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eIncontinence of mucus or feces\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 2\u003c/p\u003e\n \u003cp\u003eNo : 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 2\u003c/p\u003e\n \u003cp\u003eNo : 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 3\u003c/p\u003e\n \u003cp\u003eNo : 0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eSoiling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes 1\u003c/p\u003e\n \u003cp\u003eNo 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes 4\u003c/p\u003e\n \u003cp\u003eNo 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 0\u003c/p\u003e\n \u003cp\u003eNo : 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eAntibiotics for pouchitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes 3\u0026nbsp;\u003cbr\u003e\u0026nbsp;No 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes 5\u0026nbsp;\u003cbr\u003e\u0026nbsp;No 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 1\u0026nbsp;\u003cbr\u003e\u0026nbsp;No : 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eNumber of received treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003e2,1 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e1,5 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e1,3 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.0722891566265%\"\u003e\n \u003cp\u003eTreatment in other hospitals because of problems with the pouch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.879518072289155%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 1\u003cbr\u003e\u0026nbsp;No : 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 2\u003cbr\u003e\u0026nbsp;No : 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003eYes : 1\u003cbr\u003e\u0026nbsp;No : 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study describes the outcome and QoL of pediatric patients with UC undergoing colectomy and IPAA.\u003c/p\u003e \u003cp\u003eDifficulties that arise after surgery include: a change in bowel habits, with increased evacuations, risk of incontinence and soiling; the need to take medication to control stool and to treat inflammation of the residual rectum and pouch [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWewer Vibeke et al. questionnaire was used to assess outcomes and QoL in pediatric patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData collected at 6-month and 12-month follow-up were compared, an improvement in QoL was found in the first year after bowel reintegration. Variation in perceived health status increased comparing follow up 6 and 12 months after surgery, and the data were statistically significant. Satisfaction with surgical outcomes increased after 1 year.\u003c/p\u003e \u003cp\u003eIn the study previously conducted by Wewer et al. good satisfaction was achieved in 96% of patients, while Durno et al. found optimal functional outcomes in 90% of patients [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData at the last follow-up were collected in five patients 2\u0026ndash;4 years after ileostomy closure, in ten patients 5\u0026ndash;10 years after ileostomy closure and three patients after mor than 10 years. These patients showed excellent satisfaction with surgical outcomes. Regarding perceived health status, group of patients with more than 10 years of follow-up gave a score of 7.6/10, lower than the other groups. This difference could be attributed to several factors. First, as patients grow older, they are more aware of difficulties their condition brings in the social context. Even after ileostomy closure, patients continue to take medications to control stool or manage inflammation of the rectum or residual pouch. This may affect the perception of their overall health status. The number of bowel movements has changed significantly within a year. According to the scientific literature, one year is necessary to achieve satisfactory functional results. Twelve months are needed for the vanishing of local response to the surgical trauma, to complete the bowel adaptation, and to give the patient time to get used to the new bowel functions [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe number of defecations during the day and during the night decreased during the follow-up, also the lowest number of evacuations in 24h decreased. All these data are statistically significant and in line with the results of other previous studies. The study by Wewer et al. describes a mean of 6 evacuations during the day, 1 during the night, with lowest number of evacuations of 3 and a highest number of 10 in 24 h [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Durno et al. reported in their study that 16 patients (84%) aged 11 years or more at time of IPAA and who have had ileoanal continuity restored for at least 30 months had between 3 and 10 bowel movements in 24 h, while 16% had more than 10 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlso literature related to IPAA on adult confirms mean of 6 bowel movement during 24h, 40 months after surgery [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn patients with follow-up one year after ostomy closure, a reduction in evacuations is observed. These data agree with previously reported studies in which there is a continuous improvement in bowel movements with increasing time. Although the results are not statistically significant, our data show an improvement in pouch function from the first follow-up after 6 months compared with follow up after 1 year. Interestingly, these abilities further improve in patients with extended follow-up.\u003c/p\u003e \u003cp\u003ePellino et al. found that a high percentage of patients (92%) were able to discriminate between air and faeces and that diurnal continence was achieved by 100% of patients [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to our study data, stool consistency improved significantly between 6 months and one year after surgery and continued to improve over time, although patients had to continue taking medication.\u003c/p\u003e \u003cp\u003eMany families reported that quality and quantity of stools varies greatly in relation to diet.\u003c/p\u003e \u003cp\u003eThis often affects the social life of children, who have to adjust mealtimes. Incontinence decreases over time, but it still remains a problem, especially at night, and in girls it worsens around the time of menstruation. The studies by Wewer et al. and Durno et al. reported a much lower percentage of continent patients (50%), while Sarigold et al. and Rintala et al. had similar results to our study (72\u0026ndash;100%) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSoiling is more common than incontinence. In the study by Watanabe et al., most patients had never or only rarely experienced soiling (75%) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study we also investigated how IPAA had an impact on patient education. School absences progressively decreased through the time. Only in four patients a delay in education was present, remaining stable throughout the follow-up period. The study by Durno et al. shows that 75% of the children had no restrictions on school activities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStopping sport activities was necessary for 10 patients for the first 6 months, but one year after surgery the percentage of patients playing sports increased. These data are similar to those of Wewer et al. in which 30 percent of patients had to give up sports activities [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Durno et al. found that only 10% (3/28) gave up sports due to bowel dysfunction [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo out of five patients with 2\u0026ndash;4 years of follow-up and eight out of ten with 5\u0026ndash;10 years of follow-up play sports, while all patients more than 10 years after ostomy closure play sports. These data agree with the study by Polites et al. in which 5 years after surgery, about 50% of patients have no limitations in sports activities, after 10 years about 70% play sports [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, pouchitis has an inverse trend on other data. In fact, the percentage of patients who had at least one episode of pouchitis increases during the first year. Similar results were obtained by Wewer et al. who reported at least one episode of pouchitis in 48% of patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and the study by Durno et al. in which pouchitis occurred in 44% of cases [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies on adult patients with UC who underwent IPAA reported that all Qol domains and functional outcome were significantly worse with increasing age [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eZmora et al. suggest that the functional outcomes of pediatric patients undergoing IPAA are better than those of adults. If Qol is perceived by the patients themselves once they become adults, their responses are comparable to those of the general population. Moreover, the results of this group are better than those of UC patients undergoing IPAA as adults [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur results indicate that IPAA in pediatric patients can lead to improvement of bowel symptoms over time. However, incontinence, pouchitis and other functional problems may persist in a non-negligible percentage of patients.\u003c/p\u003e \u003cp\u003eIt can be suggested that IPAA leads to satisfactory health status and QoL for patients and that these outcomes remain stable even more than 10 years after surgery.\u003c/p\u003e \u003cp\u003eRepeating a QoL analysis with adult questionnaires when the same patients are older than 18 years could provide more information about how Qol varies over time.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUC = Ulcerative colitis (UC)\u003c/p\u003e\n\u003cp\u003eIBD = Inflammatory Bowel Disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIPAA = Ileo-J pouch-anal anastomosis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTa-IPAA = transanal approach\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQoL = quality of life\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003cstrong\u003e. \u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contribution Study conception and design: Michela Cing Yu Wong, Giulia Rotondi, Serena Arrigo, Stefano Avanzini, Paolo Gandullia, Girolamo MattioliData acquisition: Giulia Rotondi, Margherita Roso Analysis and data interpretation: Michela Cing Yu Wong, Giulia RotondiDrafting of the manuscript: Michela Cing Yu Wong, Giulia Rotondi, Margherita RosoCritical revision: Michela Cing Yu Wong(*): Modified from the authorship requirements of the J Am Coll Surg\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe declare that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.We take full responsibility for the work being reported. It is the original study and has been neither published elsewhere nor submitted for publication. Dott.ssa Giulia RotondiOn behalf of all authors\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003edata is provided within the manuscript or supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArantes JAV, dos Santos CHM, Delfino BM et al Epidemiological profile and clinical characteristics of patients with intestinal inflammatory disease. 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PMID: 12780883\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZmora O, Natanson M, Dotan I et al (2013) Long-term functional and quality-of-life outcomes after IPAA in children. Dis Colon Rectum 56(2):198\u0026ndash;204. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/DCR.0b013e3182753e10\u003c/span\u003e\u003cspan address=\"10.1097/DCR.0b013e3182753e10\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 23303148\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"IBD, colon surgery, pediatric UC, Quality of Life","lastPublishedDoi":"10.21203/rs.3.rs-4449621/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4449621/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eINTRODUCTION\u003c/strong\u003e Ulcerative Colitis (UC) is an Inflammatory Bowel Disease (IBD). Surgery is required in cases of severe acute colitis, massive hemorrhage, toxic megacolon, and perforation; in such cases colectomy and JpouchIleoanal anastomosis (IPAA) are performed. The aim of this study was to evaluate functional outcome, and patient satisfaction and Quality of Life (QoL) after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMATERIAL AND METHODS\u003c/strong\u003e Questionnaires were administered to 24 patients with UC undergoing surgery from 2011 to 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS \u003c/strong\u003eMean age at IPAA was 10.8 years. Twenty patients underwent IPAA in 3 operations, 4 patients in 2. All patients underwent laparoscopic surgery. Six months after surgery mean level of satisfaction was 8.7/10, perception of health status was 7.4. Twenty-three patients (95.8%) recommended IPAA. For 20 patients (83.3%) surgery did not cause delay in education, while 14 patients (58.3%) played sport. The lowest number of evacuations was 9.2 per day, the highest\u003c/p\u003e\n\u003cp\u003e13.3. Seventeen patients (70.8%) had no incontinence and 15 patients (62.5%) were not affected by pouchitis. After 12 months mean satisfaction level raised up to 9.2/10, perception of health status to 8.5. School absences decreased and no other patients showed any delay in education. Seventeen (70.8%) patients played sports. The number of evacuations decreased: the lowest number was 5.1 per day, the highest 7.5. Twenty patients (83.3%) were continent and 12 (50%) did not use antibiotics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION \u003c/strong\u003eMost patients show a good functional outcome in defecation frequency and continence, which has improved through time, number of pouchitis episodes has increased. Patients appear satisfied after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence\u003c/strong\u003e: III\u003c/p\u003e","manuscriptTitle":"Quality of life after Colectomy and Ileo-Jpouch-anal anastomosis in paediatric patients with Ulcerative Colitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-06 15:53:08","doi":"10.21203/rs.3.rs-4449621/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-29T07:13:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-28T07:36:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-14T13:56:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57349264612755181057735681063741440839","date":"2024-07-14T13:44:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173222313191031288427447557164560922215","date":"2024-07-14T13:10:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125909107778830606768172384833055476647","date":"2024-07-14T12:17:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-27T16:46:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-21T09:33:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-21T06:51:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Surgery International","date":"2024-05-20T14:06:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3eb0e783-dccf-4ac7-b57b-ee3eb7b9ce15","owner":[],"postedDate":"June 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-22T19:36:27+00:00","versionOfRecord":{"articleIdentity":"rs-4449621","link":"https://doi.org/10.1007/s00383-024-05824-8","journal":{"identity":"pediatric-surgery-international","isVorOnly":false,"title":"Pediatric Surgery International"},"publishedOn":"2024-08-17 15:57:52","publishedOnDateReadable":"August 17th, 2024"},"versionCreatedAt":"2024-06-06 15:53:08","video":"","vorDoi":"10.1007/s00383-024-05824-8","vorDoiUrl":"https://doi.org/10.1007/s00383-024-05824-8","workflowStages":[]},"version":"v1","identity":"rs-4449621","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4449621","identity":"rs-4449621","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}