Restorative proctocolectomy without diverting ileostomy in children with ulcerative colitis

Abstract

Purpose 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). Conclusion 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.