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Anorectal function in children after ileoanal pull-through
R C Shamberger1, C W Lillehei, S Nurko
1Department of Surgery, Children's Hospital, Harvard Medical School, Boston, MA 02115.
Insights
Mucosal proctectomy and ileoanal pull-through surgery in children offers excellent continence, avoiding permanent ileostomy. A specialized rectal training program enhances pouch function and patient adaptation for improved outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Mucosal proctectomy and ileoanal pull-through is a common procedure for children with ulcerative colitis or familial polyposis.
- This technique avoids permanent ileostomy and can achieve excellent continence.
Purpose of the Study:
- To prospectively evaluate anorectal function in children following ileoanal pull-through.
- To assess the efficacy of a biofeedback-based rectal training program.
Main Methods:
- Prospective evaluation of anorectal function in nine pediatric patients.
- Pre- and post-operative assessments including sphincter pressure measurements.
- A 6-week biofeedback rectal training program involving ileal pouch water instillations.
Main Results:
- All nine patients achieved daytime and nighttime continence.
- Median stool frequency was four movements per day, with no nocturnal movements.
- One patient experienced nocturnal incontinence and pouchitis.
Conclusions:
- Ileal pouch-anal anastomosis with rectal training is effective in achieving continence in pediatric patients.
- The biofeedback program aids in pouch adaptation and sphincter control.
- This surgical approach provides a viable alternative to permanent ileostomy.
Abstract:
Mucosal proctectomy and ileoanal pull-through is increasingly used in children requiring total colectomy for ulcerative colitis or familial polyposis. Excellent continence can be achieved with this procedure, and it avoids proctocolectomy and permanent ileostomy. We have evaluated prospectively anorectal function in nine consecutively treated children who underwent ileoanal pull-through. Patients were 8 to 17.5 years of age (median, 11.3 years) at the time of surgery; seven had ulcerative colitis, and two had familial polyposis. Anorectal evaluation was performed before colectomy and ileoanal pull-through, following ileoanal pullthrough, after rectal training, and then at yearly intervals. A biofeedback "rectal training" program was instituted 6 weeks after ileoanal pull-through and a contrast study documenting integrity of the pouch. The program consisted of an initial biofeedback session with the motility unit, followed by daily instillations, through a catheter, of progressively larger volumes of water (from 1 to 6 oz, increasing 1 oz per week) into the ileal pouch. Patients were instructed to retain the water and participate in normal activities after the instillation. This protocol acclimated the patient to sensing distension of the pouch and using the sphincters. The follow-up period ranges from 1 to 4.5 years (median, 2.2 years). All patients are continent by day and night. One patient has nocturnal incontinence with episodes of pouchitis. Stool frequency is three to eight movements per day (median, four), with none at night. Preoperative resting rectal sphincter pressures averaged 74.3 +/- 23.1 mm Hg (mean +/- standard deviation), and a maximum squeeze pressure was 93.9 +/- 25.3 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)