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Proctocolectomy and J-pouch ileo-anal anastomosis in children
1Department of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland.
Insights
J-pouch ileo-anal anastomosis (IAA) is a viable option for children needing proctocolectomy, offering excellent long-term continence and bowel function. Complications are manageable, particularly in non-immunosuppressed patients, ensuring a good quality of life.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Reconstruction
Background:
- The optimal method for ileo-anal reconstruction after proctocolectomy in children is debated.
- While ileo-anal pouch reconstruction is accepted in adults, straight ileo-anal pull-through is still favored by some pediatric surgeons.
Purpose of the Study:
- To evaluate the outcomes and long-term functional results of J-pouch ileo-anal anastomosis (IAA) in pediatric patients.
Main Methods:
- Retrospective review of 40 children undergoing J-pouch IAA between 1991 and 1999.
- Data collected included early/late complications, fecal frequency, daytime/nighttime continence, and pouchitis.
- Patient cohorts included ulcerative colitis (UC), Hirschsprung's disease (HD), and familial adenomatous polyposis (FAP).
Main Results:
- No fatalities occurred. Complications were observed in 53% of UC patients, primarily associated with systemic steroid use.
- Pouchitis affected 30% of patients; no pouches required removal.
- All patients achieved daytime continence; 2 required pads for nighttime staining. Median bowel frequency was 4/24 hours.
- HD patients experienced fewer complications, with no pouchitis and a median frequency of 3/24 hours.
Conclusions:
- J-pouch IAA is a feasible reconstruction technique in children undergoing proctocolectomy.
- Major complications are more frequent in immunosuppressed UC patients but do not preclude good functional outcomes.
- Excellent long-term continence and bowel function contribute to a high quality of life for most patients.
Background/Purpose:
The choice of ileo-anal reconstruction method in children undergoing proctocolectomy remains controversial. Although in adults ileo-anal pouch reconstruction has gained overall acceptance, many paediatric surgeons still advocate straight ileo-anal pull-through. The aim of this study was to assess the outcome and long-term functional results in children who have undergone proctocolectomy and ileo-anal anastomosis (IAA) with a J-pouch.
Methods:
Medical records of 40 consecutive children who had proctocolectomy and J-pouch IAA between 1991 and 1999 were reviewed for early and late complications, fecal frequency, day- and night-time continence, and pouchitis. The indication for surgery was ulcerative colitis (UC) in 29 (median age at operation, 13 years; range, 9 to 16), Hirschsprung's disease (HD) in 10 (median age at operation, 1.5 years; range, 1 month to 5 years), and familial adenomatous polyposis (FAP) in 1 (age at operation, 6 years). Six of the HD patients had primary pull-through for total colonic aganglionosis and 4 a redo operation for failed primary reconstruction of long segment aganglionosis.
Results:
There were no fatalities. Early complications (wound infection, early bowel obstruction, prolonged fever) occurred in 12 of 29 (41%) and late complications (bowel obstruction 9, pouch fistula 2) in 11 of 29 (38%) of the UC patients. Overall, 16 of 29 (53%) of the UC patients had complications. All patients with early complications were on systemic steroids at the time of the operation. Pouchitis occurred in 30% of the patients. None of the pouches had to be removed. At last follow-up all patients were continent during the day, 2 patients used protective pads during the night because of occasional staining. The median bowel frequency per 24 hours was 4 (range, 2 to 7); only 2 patients (7%) had to empty their bowel during the night. One (10%) of the HD patients had wound infection, and 3 had episodes of postoperative enterocolitis. Pouchitis-type symptoms have not occurred in HD patients. The median bowel frequency for 24 hours was 3 (range, 2 to 5). None of the HD patients needs to evacuate during the night. The 4 HD patients who are older than 3 years of age are continent.
Conclusions:
J-pouch IAA is a feasible method of reconstruction in children requiring proctocolectomy. Major complication are common but occur mainly in immunosuppressed patients suffering from UC. Despite high incidence of complications, long-term functional results in terms of continence and bowel frequency are excellent and ensure good quality of life in the great majority of patients.