Restorative proctocolectomy in children with ulcerative colitis utilizing rectal mucosectomy with or without diverting ileostomy

Background: Controversies continue concerning the best way to perform resto rative proctectomy (RP) for ulcerative colitis (UC). Can rectal mucosectomy and hand-sewn ileoanal anastomosis (IAA) withstand the challenge posed by extrarectal dissection with a double-stapled technique and no mucosectomy? Is a diverting ileostomy mandatory after RP? Methods: The authors describe 30 consecutive children with UC who underwent RP with rectal mucosectomy and handsewn IAA. The authors assess the result s and compare the first 14 patients (group 1) treated with temporary divert ing ileostomies with the next 16 consecutive patients (group 2) without div erting ileostomies, Results: The average age (13.8 years in group 1 v 10.4 in group 2), duratio n of illness before resection (3.2 years in group 1 v 1.5 in group 2), and gender breakdown (10 of 14 were girls in group 1, 10 of 16 were girls in gr oup 2) were similar between the two groups. Outcome was not significantly d ifferent between the two groups. Average bowel movements per 24-hour period was 5.5 in group 1 and 4.2 in Group 2. Occasional nighttime staining occur red in two patients in group 1 and five in group 2. No one suffered daytime staining in group 1, and one patient had occasional daytime staining in gr oup 2. Average quality of life (on a scale of 0 to 5) as assessed by the pa tients or parents was 4.4 in group 1 and 4.9 in group 2. There were 10 tota l complications in group 1. One child required a permanent stoma for ileoan al separation. Two patients required reoperations for complications caused by the diverting ileostomy. The single instance of peritonitis was in group 1 caused by anastomotic leak after ileostomy closure. There were five tota l complications in group 2, of which, two required temporary stomas for ile oanal separations. Conclusions: RP with rectal mucosectomy and hand-sewn IAA in children with UC provides good functional results. Peritonitis did not occur in the absen ce of diversion. Eliminating routine diverting ileostomy avoids the conside rable complications and morbidity from the stoma and its closure. Copyright (C) 1999 by W.B. Saunders Company.