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The surgical management of children with ulcerative colitis. The old vs. the new
B A Orkin1, R L Telander, B G Wolff
1Section of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Ileocolectomy with ileoanal anastomosis is a safer surgical option for children with chronic ulcerative colitis compared to older methods. This approach reduces mortality and avoids abdominal ostomies, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Chronic ulcerative colitis (CUC) management in children has evolved.
- Surgical interventions for CUC aim to improve quality of life and reduce complications.
Purpose of the Study:
- To compare the outcomes of ileoanal anastomosis with earlier surgical techniques for pediatric chronic ulcerative colitis.
- To evaluate the safety and efficacy of ileoanal anastomosis in children.
Main Methods:
- Retrospective review of 137 pediatric patients with CUC who underwent surgery between 1960 and 1984.
- Comparison of outcomes between patients undergoing total proctocolectomy with ileostomy/Kock pouch or lesser colectomy (Group I) and those with ileoanal anastomosis (Group II).
Main Results:
- Group II (ileoanal anastomosis) had a younger age at operation, 0% mortality, and no abdominal ostomies, versus 7.7% mortality and 98% ostomies in Group I.
- Urgent/emergency surgery was required in significantly fewer Group II patients (4%) compared to Group I (25%).
- Perioperative mortality was higher with emergency operations (23%) than elective procedures (1.6%).
Conclusions:
- Ileocoanal anastomosis is recommended for surgical treatment of chronic ulcerative colitis in children.
- This procedure offers improved safety and avoids the need for abdominal ostomies.
- Reduced mortality and fewer emergency interventions are key benefits of ileoanal anastomosis.
Abstract:
The authors' experience with children who have chronic ulcerative colitis was reviewed to compare their current surgical approach (ileoanal anastomosis) with earlier methods of management. Between 1960 and 1984, 137 children with chronic ulcerative colitis underwent surgery (mean duration of follow-up, 7.1 years). In 91 patients, the procedures were a total proctocolectomy with ileostomy or Kock pouch (66) or a lesser colectomy with either an ileostomy (16) or an ileorectal anastomosis (9) (group I). Forty-six patients underwent an ileoanal anastomosis procedure (group II). Children in group I were more likely to have significant preoperative loss of weight, a debilitated condition, and malnutrition. Urgent or emergency surgical intervention was required in 25 percent of patients in group I but in only 4 percent of patients in group II. Trends included 1) a younger age at operation in group II, 2) a higher mortality in group I (7.7 percent) than group II (0 percent), and 3) a higher perioperative mortality with emergency operations (23 percent) than elective procedures (1.6 percent). In group I, 98 percent of patients had an abdominal ostomy, but no patients in group II had an abdominal ostomy. The children with an ileoanal anastomosis had an average of 4.8 stools during waking hours and 1.3 stools each night. On the basis of this experience, the authors recommend use of the ileoanal anastomosis procedure in the surgical treatment of chronic ulcerative colitis in children.