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The endorectal pull-through procedure in children and young adults: a follow-up study
J Perrault1, R L Telander, A R Zinsmeister
1Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Insights
Proctocolectomy with ileoanal anastomosis offers good functional outcomes for young patients with ulcerative colitis or familial polyposis. Most patients achieve excellent continence with manageable complications, showing high satisfaction post-surgery.
Area of Science:
- Colorectal Surgery
- Pediatric Gastroenterology
- Surgical Oncology
Background:
- Chronic ulcerative colitis and familial polyposis often require surgical intervention in young patients.
- Proctocolectomy with ileoanal anastomosis is increasingly utilized for these conditions.
Purpose of the Study:
- To evaluate the functional outcomes and complications of proctocolectomy with ileoanal anastomosis in young patients.
- To compare outcomes between J-pouch and straight ileo-anal pull-through techniques.
Main Methods:
- Retrospective follow-up of 66 young patients (median age 16 years) after proctocolectomy and ileoanal anastomosis.
- Assessment via regular follow-up or comprehensive questionnaires at least 6 months post-ileostomy closure.
- Categorization into J-pouch (22 patients) and straight ileo-anal pull-through (44 patients) groups.
Main Results:
- Both J-pouch and straight ileo-anal pull-through groups reported similar stool frequency and excellent daytime continence.
- Minor complications like itching and bleeding were comparable; severe complications included small bowel obstruction (11), infection (1), and neuropathy (3).
- Early dissatisfaction with straight pull-through resolved, with overall high patient satisfaction in both groups.
Conclusions:
- Proctocolectomy with ileoanal anastomosis provides favorable functional results and high satisfaction for pediatric patients with ulcerative colitis and familial polyposis.
- While complications can occur, most are minor, and surgical techniques demonstrate good long-term efficacy.
- Both J-pouch and straight ileo-anal pull-through are viable options, with patient satisfaction improving over time.
Abstract:
At our institution, proctocolectomy with rectal mucosectomy and ileoanal anastomosis with endorectal pull-through is now the procedure of choice for young patients with chronic ulcerative colitis and familial polyposis. We have followed up 66 patients (37 male and 29 female, with a median age of 16 years) for at least 6 months after closure of the temporary ileostomy. The patients were seen regularly in follow-up or were sent a comprehensive questionnaire to assess their condition. Twenty-two patients had the construction of a J-pouch, and 44 had a straight ileo-anal pull-through. Stool frequency, day (median 4 to 7 stools) and night (median 1 to 3 stools), was similar in the two groups. Voluntary continence was excellent in both groups during waking hours. Occasional night-time incontinence in small volumes, mild perianal itching, and minimal bleeding from irritation were similar in both groups. Most of the patients could distinguish gas from stool. When medication was used, bulk agents were usually chosen, with a nonspecific antidiarrheal agent taken occasionally. A few patients with the straight ileo-anal pull-through expressed some dissatisfaction early during the follow-up period; however, all but two patients expressed satisfaction later. Of the 66 patients, 41 had at least one complication during the postoperative period; however, in 26 the complications were minor. The more severe complications included small bowel obstruction (11 patients requiring surgical decompression), infection (one patient requiring surgery), and transient neuropathy (three patients).