Ileocecal patch -low rectal anastomosis in total colectomy: New idea for the prevention of fecal incontinence.
BACKGROUND
Total colectomy is used in children with total colonic aganglionosis, Ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The purpose of this study was to maintain ileocecal valve and rectal-sparing surgery for the prevention of fecal incontinence in these children.


METHODS
From1990 to 2011, 14 children with diagnosis of UC, FAP and Hirschsprung's disease were operated. Total colectomy was done with the preservation of patch of cecum with ileocecal valve and half of the rectum with ileocecorectal anastomosis. Distal ileum designed as S shape pouch and ileocecal valve were preserved. In Hirschsprung's disease, posterior rectal myotomy was established. The data were collected and analyzed.


RESULTS
The mean age of the patients was 54 months (ranged from 2 months to 18 years). Ten patients were male. Among 14 patients, Hirschsprung's disease, ulcerative colitis and FAP were seen in 10, 3, and one case, respectively. They were followed up annually. Clinical and endoscopic examinations were performed to evaluate the function of ileocecorectal anastomosis. They followed from 2 to 24 years. At first year, the patients experienced four to six bowel movements during the day and one at night. This frequency decreased over time. The main postoperative complications included recurrent enterocolitis (n=2), perianal fistula (n=2). Only 2 patients were suffering from some degree of fecal soiling.


CONCLUSIONS
The results show that the Ileocecal patch- low rectal anastomosis in total colectomy leads to low complications and prevent fecal frequency and incontinence. It also increases absorptive function of ileum in children.
Department of Pediatric Surgery, Pediatric Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Valiullah
V
Mehrabi
Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Leily
L
Mohajerzadeh
Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Alireza
A
Mirshemirani
Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ahmad
A
Khaleghnejad Tabari
Department of Pediatric Surgery, Pediatric Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Azadeh
A
Falahi
Department of Pediatric Surgery, Pediatric Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Shabnam
S
Abtahi
Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Marjan
M
Kafaei
Hirschsprung.; Ileocecal patch; Total colostomy; Ulcerative colitis