Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1992 Jan;215(1):57–62. doi: 10.1097/00000658-199201000-00008

Long-term results after colectomy and endorectal ileal pullthrough procedure in children.

E W Fonkalsrud 1, N Loar 1
PMCID: PMC1242370  PMID: 1309989

Abstract

Since 1987, 67 children with ulcerative colitis, 14 with colonic polyposis, and one with Hirschsprung's disease have undergone colectomy and endorectal ileal pullthrough procedures (ERP). Seventy-six children had a lateral ileal reservoir and six had a straight pullthrough. Seventy-seven patients had a diverting ileostomy for 4 months; five polyposis patients underwent ERP without ileostomy. Forty-three (52%) developed complications, including ileoanal stenosis with reservoir outlet obstruction (14), elongated ileal spout (2), elongated ileal reservoir greater than 15 cm (4), and a combination of outflow obstruction, reservoir enlargement causing stasis (14), and intestinal obstruction causing obstruction (10). Thirty-two children required reoperation. Sixty per cent of complications occurred in the first 30 patients. Only three of the last 40 patients had reoperation. There were no deaths. Four children (two with Crohn's disease) returned to a permanent ileostomy (4.9%); 10 had a temporary ileostomy. Five straight pullthroughs were converted to a reservoir because of stool frequency; 19 underwent reservoir reconstruction because of stasis. Seventy-five children (91.5%) are currently progressing very well. Features for optimal function include a short rectal muscle cuff, a short reservoir and spout, and aggressive correction of rectal strictures. The ERP is a desirable option to proctocolectomy and ileostomy for children with colitis or polyposis.

Full text

PDF
57

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Dozois R. R., Kelly K. A., Welling D. R., Gordon H., Beart R. W., Jr, Wolff B. G., Pemberton J. H., Ilstrup D. M. Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. Ann Surg. 1989 Sep;210(3):268–273. doi: 10.1097/00000658-198909000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Fonkalsrud E. W., Phillips J. D. Reconstruction of malfunctioning ileoanal pouch procedures as an alternative to permanent ileostomy. Am J Surg. 1990 Sep;160(3):245–251. doi: 10.1016/s0002-9610(06)80016-4. [DOI] [PubMed] [Google Scholar]
  3. Fonkalsrud E. W., Stelzner M., McDonald N. Construction of an ileal reservoir in patients with a previous straight endorectal ileal pull-through. Ann Surg. 1988 Jul;208(1):50–55. doi: 10.1097/00000658-198807000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fonkalsrud E. W., Stelzner M., McDonald N. Experience with the endorectal ileal pullthrough with lateral reservoir for ulcerative colitis and polyposis. Arch Surg. 1988 Sep;123(9):1053–1058. doi: 10.1001/archsurg.1988.01400330029003. [DOI] [PubMed] [Google Scholar]
  5. Fonkalsrud E. W. Total colectomy and endorectal ileal pull-through with internal ileal reservoir for ulcerative colitis. Surg Gynecol Obstet. 1980 Jan;150(1):1–8. [PubMed] [Google Scholar]
  6. Galandiuk S., Scott N. A., Dozois R. R., Kelly K. A., Ilstrup D. M., Beart R. W., Jr, Wolff B. G., Pemberton J. H., Nivatvongs S., Devine R. M. Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. Ann Surg. 1990 Oct;212(4):446–454. doi: 10.1097/00000658-199010000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Martin L. W., LeCoultre C., Schubert W. K. Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg. 1977 Oct;186(4):477–480. doi: 10.1097/00000658-197710000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Morgan R. A., Manning P. B., Coran A. G. Experience with the straight endorectal pullthrough for the management of ulcerative colitis and familial polyposis in children and adults. Ann Surg. 1987 Nov;206(5):595–599. doi: 10.1097/00000658-198711000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Orkin B. A., Telander R. L., Wolff B. G., Perrault J., Ilstrup D. M. The surgical management of children with ulcerative colitis. The old vs. the new. Dis Colon Rectum. 1990 Nov;33(11):947–955. doi: 10.1007/BF02139104. [DOI] [PubMed] [Google Scholar]
  10. SOAVE F. A NEW SURGICAL TECHNIQUE FOR TREATMENT OF HIRSCHSPRUNG'S DISEASE. Surgery. 1964 Nov;56:1007–1014. [PubMed] [Google Scholar]
  11. Schoetz D. J., Jr, Coller J. A., Veidenheimer M. C. Ileoanal reservoir for ulcerative colitis and familial polyposis. Arch Surg. 1986 Apr;121(4):404–409. doi: 10.1001/archsurg.1986.01400040040005. [DOI] [PubMed] [Google Scholar]
  12. Stelzner M., Fonkalsrud E. W., Lichtenstein G. Significance of reservoir length in the endorectal ileal pullthrough with ileal reservoir. Arch Surg. 1988 Oct;123(10):1265–1268. doi: 10.1001/archsurg.1988.01400340091015. [DOI] [PubMed] [Google Scholar]
  13. Wexner S. D., Jensen L., Rothenberger D. A., Wong W. D., Goldberg S. M. Long-term functional analysis of the ileoanal reservoir. Dis Colon Rectum. 1989 Apr;32(4):275–281. doi: 10.1007/BF02553479. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES