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Total Abdominal Colectomy and Ileal Pouch - Anal Anastomosis in Children
Craig W Lillehei, Alan Leichtner, Athos Bousvaros, Robert C. Shamberger
Boston Children's Hospital, Boston, MA

Objective: To evaluate the results of total abdominal colectomy (TAC) and ileal pouch-anal anastomosis (IPAA) in children.
Design: Case series
Setting: Academic pediatric referral center
Patients: Retrospective review of 100 consecutive referred children (<18 years old) who underwent above surgery by same 2-surgeon team.
Intervention: Synchronous abdominoperineal IPAA with J-pouch of ileum and preservation of transitional anorectal epithelium. Temporary diverting ileostomy always employed. Simultaneous TAC and IPAA if condition of rectal mucosa permitted.
Main Outcome Measures: Daytime and nocturnal fecal continence. Bowel movements per day. Complications including pouchitis, IPAA stricture and postoperative small bowel obstruction.
Results: Average age of the 100 children (48 males/52 females) was 13.3 years (2.95-17.99). All 25 patients with familial adenomatous polyposis (FAP) had TAC and IPAA performed simultaneously. However, of 75 children with ulcerative colitis (UC), 48 (64%) had TAC alone followed by IPAA after an interval ranging from 2 months to 4.5 years. Daytime fecal continence was achieved in 98 although 4 of these reported a rare accident. Nighttime continence was achieved in 93 of whom 14 reported a rare accident. Average frequency of bowel movements was 5.43/day (+/- 2.22). Only one child with FAP had an episode of pouchitis. However, of the 75 children with UC at least 35 had symptoms consistent with pouchitis and 10 required prolonged treatment. The most frequent postoperative complication was IPAA stricture requiring operative dilatation and/or anoplasty in 18. Small bowel obstruction requiring surgery occurred in 15. One child eventually required pouchectomy.
Conclusions: Excellent results can be achieved with IPAA in children with respect to fecal continence and stool frequency. However, in those with UC there remains a substantial risk of pouchitis.


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