ILEAL POUCH-ANAL ANASTOMOSIS IN CHILDREN WITH ULCERATIVE-COLITIS

This study is a retrospective review of all pe diatric patients with u lcerative colitis who underwent colectomy and ileal pouch-anal anastom osis (IPAA) between 1982 and 1992 at the Cleveland Clinic Foundation. The purpose of the review was to determine the effectiveness of IPAA i n treating children with ulcerative colitis. Demographic, preoperative , and surgical data were abstracted from archival research of medical records. Quality-of-life information was obtained from patient or pare nt interviews. Ninety-one children were identified during the study pe riod with a median age of 14.2 years. The principal indication for col ectomy was intractable symptoms despite vigorous medical therapy. J-po uches (n = 51) and S-pouches (n = 38) were most commonly constructed. Median follow-up was 1.9 years after ileostomy closure. Thirty early c omplications (occurring within 30 days of pouch construction) were doc umented in 21 patients, and 57 late complications (occurring after 30 days) were documented in 34 patients. Small bowel obstruction was the most common early postoperative complication and accounted for 13 of 3 0 early complications; reoperation was required in four of nine patien ts. Pouchitis was the most frequent late complication (15 episodes in 12 patients), followed by perineal infection (14 episodes in eight pat ients), and anastomotic stricture (10 episodes in nine patients). Pouc h type, age at colectomy, and disease interval from colectomy to pouch construction were analyzed with relation to the frequency of pouchiti s, anastomotic stricture, sepsis, and incontinence. An S-pouch had bee n used in eight of nine patients with an anastomotic stricture (p = 0. 004). The disease interval and age at initial surgery had no bearing o n the presence of late complications. The pouches of four female patie nts were excised as a result of pelvic infection and were subsequently converted to continent ileostomies. Quality-of-life information was o btained for 78 patients. Daytime continence was complete in 67 (86%) c hildren and nocturnal continence was complete in 56 (72%) patients. Se venty-three (94%) patients were very satisfied with their quality of l ife after IPAA. We conclude that IPAA is an effective surgical procedu re for children with ulcerative colitis and results in a relatively no rmal pattern of defecation with a good long-term functional outcome. E arly postoperative complications are common, but only a few patients r equire further hospitalization or surgery. The most common late compli cation is pouchitis, which responds to medical treatment, Continence i s preserved in the majority of the children, and overall satisfaction with the operation is high.