Value of histopathology for predicting the post-operative complications of ileo-anal anastomosis (J-pouch) procedure in children with refractory ulcerative colitis

Histologic inflammatory activity of the rectal margin as a predictor of postoperative complication in ileoanal anastomosis (J-pouch) procedure in children with refractory ulcerative colitis

“…As chronic inflammation is almost invariably present in patients with refractory ulcerative colitis, it was not analyzed. Its noncontributory role is further supported by previous study [6].…”

“…Using this tool, only activity at the rectoanal margin at the time of surgery has been associated with a significant risk for developing postoperative complications [6]. Interestingly, even the histologic inflammatory activity at the most involved portion of rectum was not associated with postoperative complications in our previous study [6].…”

“…The results of our retrospective, single center study suggest that targeted mucosal biopsy of the rectoanal transition zone prior to J-pouch procedure may be an option to consider in order to defer timing of the operation until medical remission is obtained. Given the refractory nature of UC, full medical remission is not possible; however results from a study investigating the impact of disease activity from the proximal and distal surgical donuts, and the most involved segment of rectum suggest that only disease activity at the rectal margin impacts postoperative complication [6]. Thus, additional short-term and local therapy such as hydrocortisone suppositories and/or enemas may assist in achieving local remission at the rectoanal margin, and accordingly diminish complication rates.…”