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Surgery for ulcerative colitis in pediatric patients: functional results of 10-year follow-up with straight
Emanuela Ceriati1, Fiorella Deganello, Francesco De Peppo
1Department of Paediatric Surgery, Paediatric Hospital Bambino Gesù, Via Cassia 569, 00189 Rome, Italy. ceriati@opbg.net
Insights
Endorectal pull-through (ERPT) surgery for pediatric ulcerative colitis (UC) shows varied outcomes. While many patients report good emotional health, significant fecal incontinence affects over half, necessitating further research into surgical techniques.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Ulcerative colitis (UC) in children and adolescents often necessitates colectomy due to persistent symptoms.
- Surgical intervention is a critical consideration for refractory pediatric UC cases.
- Endorectal pull-through (ERPT) is one surgical approach evaluated for this patient population.
Purpose of the Study:
- To present a 10-year follow-up experience with endorectal pull-through (ERPT) surgery for ulcerative colitis (UC) in pediatric patients.
- To evaluate surgical complications, functional outcomes (stooling patterns, fecal incontinence), and quality of life post-ERPT.
- To provide data supporting the need for comparative studies on surgical techniques in pediatric UC.
Main Methods:
- Retrospective chart review of 28 pediatric and adolescent patients who underwent ERPT for UC.
- Evaluation of patient data including age at colectomy, indications, operative details, and early/late complications.
- Assessment of stooling frequency, consistency, urgency, fecal continence, and self-reported quality of life.
Main Results:
- Stooling frequency varied, with 10 patients defecating more than six times daily; stool consistency was normal in 14 patients.
- Fecal continence was reported as perfect or good in 47% of patients, while 52% experienced moderate to total incontinence.
- Most patients reported good emotional health and successful adaptation to school and daily life post-surgery.
Conclusions:
- ERPT surgery for pediatric UC presents a complex profile of functional outcomes, particularly regarding fecal incontinence.
- Despite challenges with continence, many young patients demonstrate resilience and adapt well emotionally and socially.
- Further research comparing different surgical techniques for pediatric UC is essential to optimize long-term results and quality of life.
Abstract:
Children and adolescents affected by ulcerative colitis (UC) frequently require colectomy because of refractory or chronic symptoms. The aim of this paper is to present our experience and 10-year follow-up results of 28 patients who underwent endorectal pull-through (ERPT) as surgical treatment for UC, with special regard to surgical complications, stooling patterns (frequency of defecation, stool consistency, urgency period), fecal incontinence, and quality of life. A retrospective chart review of these patients was performed to evaluate age at colectomy, indication for surgical treatment, operative procedures, technical details, and early or late complications. Frequency of defecation was less than twice per day in two patients, between three and five times per day in nine patients, and more than six times per day in 10 patients. Stool consistency was normal in 14 patients, loose in five, and liquid in only two cases. Urgency period was normal (minutes) in 14 patients, short (seconds) in four, and absent in three. Ten patients (47%) have perfect or good fecal continence, whereas 11 (52%) patients present moderate to total incontinence. The self-reported emotional health was good in most of the patients. A large number are progressing well at school and are coping with their operations. Studies of quality of life in UC patients who underwent surgical treatment in childhood or adolescence, comparing as well the results according to the surgical technique adopted, must be encouraged.
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