RESTORATIVE PROCTOCOLECTOMY IN CHILDREN AND ADOLESCENTS

Children and adolescents with colitis present specific problems for su rgeons. There has been a fashion, particularly in North America, for r estoring continuity after colectomy by a direct ileo-anal anastomosis. The authors reviewed their experience with restorative proctocolectom y with ileal reservoir (RPC) in patients under 18 years of age to eval uate the outcome and to discuss the problems and challenges associated with the procedure in this age group. Fifteen patients (6 boys, 9 gir ls) were operated on between 1984 and 1995. The diagnoses included 12 patients with ulcerative colitis (UC), two with familial adenomatous p olyposis (FAP), and one with total colonic neuronal dysplasia. The med ian age of the patients at the time of ileal pouch formation was 15 ye ars, and follow-up data were available for all patients at a median of 43 months. Ten patients with UC underwent pouch surgery 4 to 14 month s after initial total abdominal colectomy (7 for acute severe disease, 3 for chronic disease), Four patients (2 with chronic UC, 2 with FAP) underwent primary RPC. There were no deaths in this series. Three (20 %) patients suffered serious early morbidity (pouch hemorrhage, pelvic sepsis, severe psychological crisis), Late morbidity included three p atients who had small bowel obstruction, one who required laparotomy, two who required pouch revision, and five of 12 (42%) patients with UC who presented with a documented episode of pouchitis between 2 and 72 months after ileostomy closure, All patients had acceptable bowel fre quency and quality of continence. This experience suggests that RPC pr ovides an important surgical option for children and adolescents with UC or FAP. (C) BMJ Publishing Group.