title: Restorative proctocolectomy without diverting ileostomy in children with ulcerative colitis.
abstract: OBJECTIVE
  The safety of performing a restorative proctocolectomy (RP) and J-pouch ileoanal anastomosis (IPAA) without diverting ileostomy for children with ulcerative colitis (UC) is a subject of extensive debate. Our goal was to examine pediatric outcomes of RP and IPAA without ileostomy.
  
  
  METHODS
  We performed a single-institution review of UC patients who had RP and IPAA with (+Ostomy) or without (-Ostomy) diverting ileostomy from 2002 to 2010. Surgeon and patient preference determined ileostomy decision. The study included 50 patients (28 +Ostomy, 22 -Ostomy).
  
  
  RESULTS
  Preoperative demographics were similar between 2 groups in age (13.5 ± 3.5 years -Ostomy, 14.3 ± 3 years +Ostomy), serum albumin (3.6 ± 0.7 -Ostomy, 3.6 ± 0.7 +Ostomy), body mass index (20.8 ± 6.9 -Ostomy, 21.3 ± 8.6 +Ostomy), and daily corticosteroid dose (22.4 ± 17.7 mg -Ostomy, 23.5 ± 13.7 mg +Ostomy). Operating time was less in -Ostomy with mean times of 6:22 ± 2:04 vs 9:07 ± 2:57. The -Ostomy group required fewer ileoanal anastomotic dilations per patient (0.4 ± 0.8 vs 1.4 ± 1.9). Functional outcomes were not significantly different regarding pouchitis episodes per patient (0.6 ± 1.1 -Ostomy, 0.6 ± 1.1 +Ostomy), daily bowel movements (5.5 ± 1.9 -Ostomy, 6.7 ± 4.0 +Ostomy), and daily postoperative loperamide dose (8.4 ± 4.3 mg -Ostomy, 6.8 ± 4.0 mg +Ostomy).
  
  
  CONCLUSIONS
  Short- and long-term outcomes can be equivalent in patients with and without diverting ileostomy, but questions remain regarding patient selection and quality of life impact.
authors.affiliation: Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI 48109, USA. briangra@med.umich.edu
authors.forename: Brian W
authors.initials: BW
authors.lastname: Gray
authors.forename: Robert A
authors.initials: RA
authors.lastname: Drongowski
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: James D
authors.initials: JD
authors.lastname: Geiger
mesh_terms: D000293:Adolescent; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies