OUTCOME AFTER ILEOANAL ANASTOMOSIS IN PEDIATRIC-PATIENTS WITH ULCERATIVE-COLITIS

Background: To review the outcome after restorative proctocolectomy am ong children and adolescents with ulcerative colitis at a pediatric in flammatory bowel disease center. Methods: The records of all patients with ulcerative colitis undergoing colectomy and ileoanal anastomosis at The Hospital for Sick Children, Toronto, Canada, were reviewed. Que stionnaires concerning functional results were sent to patients with r estored transanal defecation. Results: Seventy three patients (mean ag e, 13.2 years; range, 2.6-18.8 years) underwent ileoanal anastomosis ( 19 straight ileoanal anastomosis, 41 J pouch, 13 S pouch) between Janu ary 1980 and June 1995 and were observed 5.8 +/- 3.3 years. The ileoan al anastomosis is nonfunctional in 19 (26%) patients. Excision rates a ccording to type of restorative procedure were J pouch, 7% (3 of 41); S pouch, 32% (4 of 13); and straight ileoanal anastomosis, 32% (6 of 1 9). Failure was usually attributable to intractable diarrhea among pat ients with straight ileoanal anastomosis but was caused by anastomotic leak or pelvic-perianal sepsis among patients with pouch procedures. Failure rates did not vary with age at ileoanal anastomosis. Among pat ients retaining ileoanal continuity, continence problems reported in t he questionnaire were frequent and tended to be more extreme among you nger patients. Overall, 90% of respondents reported satisfaction with the functional outcome of the restorative operation. Conclusions: The success rate of the ileoanal anastomosis/J-pouch procedure is comparab le to that in adult series. The ileoanal anastomosis/J-pouch procedure is the operation of choice for children and adolescents who want ileo anal continuity restored after colectomy for ulcerative colitis.