Restorative proctocolectomy for pediatric patients with ulcerative colitis.
OBJECTIVE
A restorative proctocolectomy has become an elective surgical treatment for patients with ulcerative colitis (UC). In children with UC, however, the role of this procedure has not yet been well evaluated. We investigated the postoperative status of pediatric patients with UC regarding the side effects of steroids, postoperative complications, and growth.


METHODS
The medical records of 15 patients with UC who underwent a restorative proctocolectomy between August 1993 and October 2003 were retrospectively reviewed.


RESULTS
Their mean age was 12.6 +/- 3.4 years (range 5.7-15.7; boys: 9, girls: 6). All patients had total colitis, except for one who had left-sided colitis. The mean cumulative dose of preoperative prednisolone was 6201 +/- 7980 mg (mean +/- SD). The operative indications were an unsuccessful response to medical treatments in 12 patients (80%) and severe colitis in 3 patients (20%). Surgery was performed in one stage in 6 patients and in two stages in 9 patients. Seven patients (47%) demonstrated growth retardation at the time of operation. Steroid-related complications were seen in 3 cases, i.e., steroid myopathy, glaucoma, and cataracts, respectively. As early postoperative complications, an intestinal obstruction was seen in 2 patients, peritonitis in 1, and pancreatitis in 1. As late complications, anastomotic stenosis was observed in 5 patients, pouchitis in 4, residual proctitis in 3, and anal or proctovaginal fistula in 2. An intestinal obstruction, peristomal pyoderma gangrenosum, and dehydration each was seen in 1 patient. A growth "catch-up" was obtained for all but one patient. All patients became free of corticosteroids.


CONCLUSIONS
A restorative proctocolectomy was found to be an effective treatment alternative even in children with UC when conservative therapy proves to be ineffective.
Sako
Minako
M
Department of Surgery, Yokohama City Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan.
Kimura
Hideaki
H
Arai
Katsuhiko
K
Koganei
Kazutaka
K
Kito
Fumihiko
F
Sugita
Akira
A
Fukushima
Tsuneo
T
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000367:Age Factors; D001827:Body Height; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones