Straight Ileoanal Anastomosis and Ileal Pouch-Anal Anastomosis in the Surgical Management of Idiopathic Ulcerative Colitis and Familial Polyposis Coli in Children

Abstract

We compared the postoperative course in children and teenagers who underwent subtotal colectomy, mucosal proctectomy, and either straight ileoanal anastomosis (group 1, n = 8) or ilegal pouch-anal anastomosis (group 2, n =10) for the surgical treatment of idiopathic ulcerative colitis (n = 15) and familial polyposis coli (n = 3). Two of eight children in group 1 developed intractable diarrhea that persisted despite revision of the anastomosis to include an ileal pouch; therefore, ileostomies were necessary in both case. One patient in group 2 had a diverting ileostomy as a result of abscess fromation at the site of the ileoanal anastomosis. Despite a longer period of postoperative follow-up (48.9 .+-. 11.8 months), the remaining six patients in groups 1 had a significantly greater number of bowel movements each day (7.8 .+-. 6.5) as compared with the nine patients in group 2 who had a 4.8 .+-. 2.6 stools each day (p < 0.05) at a mean follow-up of 15.7 .+-. 9.0 months. A proportion of children in both groups had a poor postoperative functional outcome as determined by fecal incontinence (2 of 6 in group 1, 6 of 9 in group 2), perianal dermatitis (2 of 6, 4 of 9), and therapy with the antidiarrheal agent loperamide (4 of 6, 2 of 9). Increased school attendance (5 of 6, 7 of 7) and improvement in level of participation in social activities (5 of 6, 7 of 7) as compared with the 6-month period prior to surgery occurred, however, for most of the children with ulcerative colitis in both groups. We conclude that although significant complications can develop following the formation of an ileoanal anastomosis, with or without an ileal reservoir, many children achieve a good functional outcome.