title: Outcome after ileoanal anastomosis in pediatric patients with ulcerative colitis.
abstract: BACKGROUND
  To review the outcome after restorative proctocolectomy among children and adolescents with ulcerative colitis at a pediatric inflammatory 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. Questionnaires concerning functional results were sent to patients with restored transanal defecation.
  
  
  RESULTS
  Seventy three patients (mean age, 13.2 years; range, 2.6-18.8 years) underwent ileoanal anastomosis (19 straight ileoanal anastomosis, 41 J pouch, 13 S pouch) between January 1980 and June 1995 and were observed 5.8+/-3.3 years. The ileoanal anastomosis is nonfunctional in 19 (26%) patients. Excision rates according 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 19). Failure was usually attributable to intractable diarrhea among patients 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 patients retaining ileoanal continuity, continence problems reported in the questionnaire were frequent and tended to be more extreme among younger 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 comparable to that in adult series. The ileoanal anastomosis/J-pouch procedure is the operation of choice for children and adolescents who want ileoanal continuity restored after colectomy for ulcerative colitis.
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Durno
authors.forename: P
authors.initials: P
authors.lastname: Sherman
authors.forename: K
authors.initials: K
authors.lastname: Harris
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Dupuis
authors.forename: B
authors.initials: B
authors.lastname: Shandling
authors.forename: D
authors.initials: D
authors.lastname: Wesson
authors.forename: R
authors.initials: R
authors.lastname: Filler
authors.forename: R
authors.initials: R
authors.lastname: Superina
authors.forename: A
authors.initials: A
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D019449:Pouchitis / Q000175:diagnosis; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome