Restorative proctocolectomy for ulcerative colitis in children— Is the J-pouch better than straight pull-through?

Abstract

Proctocolectomy and ileoanal anastomosis (IAA), with or without an ileal pouch, is the preferred method for the surgical treatment of ulcerative colitis (UC) in children. The authors compared the surgical complications and functional outcome for patients with UC who had proctocolectomy and straight IAA with those of patients who had proctocolectomy and IAA with a J-pouch. Twenty-two children (aged 7 to 15 years) with intractable UC had an IAA, 11 by straight ileoanal anastomosis (SIAA) and 11 with a J-pouch (JIAA). The median clinical and endoscopic follow-up period for SIAA patients was 4 years (range, 3.0 to 6.5 years); for JIAA patients it was 2 years (range, 1 to 3 years). The frequency of daytime and nighttime defecation was significantly higher ( P < .03) for patients with SIAA at 3, 6, and 12 months postoperatively. At the last follow-up visit, the mean frequency of defecation for patients with SIAA was 6.1 ± 2.5/d; that for patients with JIAA was 3.3 ± 0.5/d ( P < .03). Six of 10 patients with SIAA but none with JIAA had nighttime bowel evacuations. None of the patients had daytime soiling; 3 with SIAA and 2 with JIAA had slight soiling during sleep. There was no significant difference in the incidence of early (SIAA 27% v JIAA 45%) and late (SIAA 54% v JIAA 27%) surgical complications between the two groups. Endoscopically confirmed symptomatic pouchitis during the first post-operative year was found in 4 of the 11 (36%) patients with SIAA and in 2 of the 11 (18%) with JIAA (difference not significant). The early and long-term functional results of JIAA are superior to those of SIAA. There is no difference in the incidence of surgical complications and pouchitis between JIAA and SIAA patients.