LONG-TERM RESULTS AFTER COLECTOMY AND ILEOANAL PULL-THROUGH PROCEDUREIN CHILDREN

Objective: To review the clinical experience with colectomy and ileoan al pull-through procedure in children from 1 hospital. Design: Since 1 977, 116 children 18 years of age or younger underwent colectomy and i leoanal pull-through procedure at University of California-Los Angeles Medical Center. Ninety-four children had ulcerative colitis, 17 had f amilial polyposis coli, and 5 had Hirschsprung disease. Sixty-two chil dren had a lateral pouch, 47 aJ-pouch, and 7 a straight pull-through. A diverting ileostomy was used for 4 months for all patients except 9 with Polyposis coli and 2 with Hirschsprung disease. During the same p eriod, an additional 414 patients older than 18 years underwent the il eoanal pull-through procedure. Results: Forty-eight children (41%) dev eloped complications; the most common was pouchitis, which occurred in 18 patients with ulcerative colitis. Forty-two children underwent reo peration; 38 had ulcerative colitis. There were no deaths. Six childre n (5.2%) (3 with Crohn disease) required a permanent ileostomy. Six st raight pull-throughs were converted to J-pouches because of stool freq uency; 19 patients with lateral pouches underwent pouch reconstruction or spout resection because of stasis. With a mean follow-up of 7.1 ye ars, 107 children (92.2%) were progressing well. Conclusions: Ulcerati ve colitis is a more severe disease in children. The ileoanal pull-thr ough procedure is the preferred operation for children with ulcerative colitis, polyposis coli, and selected patients with Hirschsprung dise ase. The J-pouch is preferred because of simplicity of construction an d scarcity of complications.