August 1996

Long-term Results After Colectomy and Ileoanal Pull-Through Procedure in Children

Author Affiliations

From the Division of Pediatric Surgery, University of California—Los Angeles School of Medicine.

Arch Surg. 1996;131(8):881-886. doi:10.1001/archsurg.1996.01430200091016

Objective:  To review the clinical experience with colectomy and ileoanal pull-through procedure in children from 1 hospital.

Design:  Since 1977, 116 children 18 years of age or younger underwent colectomy and ileoanal pull-through procedure at University of California—Los Angeles Medical Center. Ninety-four children had ulcerative colitis, 17 had familial polyposis coli, and 5 had Hirschsprung disease. Sixty-two children had a lateral pouch, 47 a J-pouch, and 7 a straight pull-through. A diverting ileostomy was used for 4 months for all patients except 9 with polyposis coli and 2 with Hirschsprung disease. During the same period, an additional 414 patients older than 18 years underwent the ileoanal pull-through procedure.

Results:  Forty-eight children (41%) developed complications; the most common was pouchitis, which occurred in 18 patients with ulcerative colitis. Forty-two children underwent reoperation; 38 had ulcerative colitis. There were no deaths. Six children (5.2%) (3 with Crohn disease) required a permanent ileostomy. Six straight pull-throughs were converted to J-pouches because of stool frequency; 19 patients with lateral pouches underwent pouch reconstruction or spout resection because of stasis. With a mean follow-up of 7.1 years, 107 children (92.2%) were progressing well.

Conclusions:  Ulcerative colitis is a more severe disease in children. The ileoanal pull-through procedure is the preferred operation for children with ulcerative colitis, polyposis coli, and selected patients with Hirschsprung disease. The J-pouch is preferred because of simplicity of construction and scarcity of complications.Arch Surg. 1996;131:881-886