[Long-term results in ulcerative colitis treated with proctocolectomy and ileoanostomy in children].
OBJECTIVE
The treatment of Ulcerative Colitis (UC) unresponsive to current medical treatment involves total proctocolectomy and ileanostomy. The aim of this study was to assess the long term results in such patients.


METHODS
We reviewed children treated from 1992 to 2008. The operations, complications and functional outcome were recorded. For those with preserved rectal defecation, continence (Holschneider score) and quality of life (standardized phone questionnaire) were assessed in the long term.


RESULTS
104 patients had Ulcerative Colitis (UC) and 3 undetermined colitis (excluded from the study). 26/104 UC patients (26%) aged 10.7 +/- 4.1 years required 82 operations. Eight had emergency colectomy for toxic megacolon (3, one death) or severe hemorrhage (5). 25 had restorative proctocolectomy and ileoanostomy (RPCIA) without (16) or with (9) J-pouch under protective ileostomy. Complications were frequent (40%). Permanent ileostomy was required in 5 children (20%). Twelve months postoperatively, RPCIA patients had 6.3 +/- 3 stools/day, all were continent during daytime and 25% have nocturnal leaks. Mean Holschneider score (0-12) was 8.8 +/- 2. Quality of life was good in all with normal school (all) or university attendance (7), 4 work and 60% of those older than 18 have sexual partners.


CONCLUSIONS
The nature of UC involves risky and frustrating surgery. However, it may provide a reasonably good quality of life for UC patients after the first year. Pediatric surgeons should be able to provide adequate preoperative counseling to patients and families.
Barrena
S
S
Departamento de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid.
Martínez
L
L
Hernández
F
F
Lassaletta
L
L
Lopez-Santamaría
M
M
Prieto
G
G
Larrauri
J
J
Tovar
J A
JA
D001003:Anal Canal / Q000601:surgery*; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D006801:Humans; D007081:Ileostomy; D016737:Proctocolectomy, Restorative; D013997:Time Factors; D016896:Treatment Outcome