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Updated: Aug 8, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Surgical management of inflammatory bowel disease
M E Ba'ath1, M W Mahmalat, P Kapur
1Department of Paediatric Surgery, Royal Liverpool Children's Hospital NHS Trust, Liverpool, UK.
Insights
Surgical outcomes for pediatric inflammatory bowel disease (IBD) show limited resection is safe for Crohn's disease proximal to the left colon. For disease distal to the transverse colon, subtotal colectomy is preferred over anastomosis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Inflammatory bowel disease (IBD) in children often necessitates surgical intervention.
- Evaluating surgical outcomes and morbidity is crucial for optimizing treatment strategies in pediatric IBD patients.
Purpose of the Study:
- To assess the outcomes and complication rates associated with major surgical procedures for pediatric inflammatory bowel disease (IBD).
- To determine the safety and efficacy of different surgical approaches for Crohn's disease and ulcerative colitis in children.
Main Methods:
- Retrospective analysis of 227 pediatric IBD cases treated between 1994 and 2002.
- Review of surgical interventions, including resections, anastomoses, and reconstructions, and their associated morbidities.
Main Results:
- For Crohn's disease, 21% of patients required surgery. Limited resection with primary anastomosis was safe for disease proximal to the left colon (0% morbidity). However, conservative segmental resections for disease distal to the transverse colon had a 100% complication rate.
- For ulcerative colitis, 22% of patients underwent surgery. J-pouch ileoanal anastomosis yielded good functional outcomes (continence in 10/11 children). Straight ileoanal anastomosis resulted in unacceptable stool frequency in all patients.
- Overall complication rates were 57% for Crohn's disease surgery and 31% for ulcerative colitis surgery.
Conclusions:
- Limited segmental resection with primary anastomosis is a safe and effective surgical option for pediatric Crohn's disease proximal to the left colon.
- For pediatric Crohn's disease distal to the transverse colon, subtotal or panproctocolectomy is recommended, avoiding anastomosis due to high complication rates.
- J-pouch reconstruction offers good functional outcomes for pediatric ulcerative colitis, while straight ileoanal anastomosis has a high failure rate.
Aim:
To evaluate the outcome and morbidity after major surgical interventions for inflammatory bowel disease (IBD).
Methods:
Retrospective case note analysis of 227 children referred to a tertiary referral centre between 1994 and 2002 for treatment of IBD.
Results:
26 of 125 children with Crohn's disease (21%) required surgical management. 13 with disease proximal to the left colon underwent limited segmental resections and primary anastomosis, without significant morbidity. Primary surgery for 13 children with disease distal to the transverse colon included 6 subtotal-colectomies or panprocto-colectomies. All seven children undergoing conservative segmental resections (three with primary anastomosis, four with stoma formation), required further colonic resection or defunctioning stoma formation. All three children undergoing primary anastomosis developed a leak or fistula formation. 22 of 102 children with ulcerative colitis (22%) required surgery. Definitive procedures (n = 17) included J-pouch ileoanal anastomosis (n = 11), ileorectal anastomosis (n = 2), straight ileoanal anastomosis (n = 3), and proctectomy/ileostomy (n = 1). Five children await restorative surgery after subtotal colectomy. Median daily stool frequency after J-pouch surgery was 5 (range 3-15), and 10 of 11 children reported full daytime continence. All three children with straight ileoanal anastomosis had unacceptable stool frequency and remain diverted.
Conclusion:
The complication rate after resectional surgery for IBD was 57% for Crohn's disease, and 31% for ulcerative colitis. In children with Crohn's disease, limited resection with primary anastomosis is safe proximal to the left colon. Where surgery is indicated for disease distal to the transverse colon, subtotal or panproctocolectomy is indicated, and an anastomosis should be avoided. Children with ulcerative colitis had a good functional outcome after J-pouch reconstruction. However, the overall failure rate of attempted reconstructive surgery was 24%, largely owing to the poor results of straight ileoanal anastomosis.
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