Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. 1377-1382 (doi:10.1542/peds.2008-2086)
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ARTICLE

Long-term Outcomes of Restorative Proctocolectomy in Children With Ulcerative Colitis

Mikko P. Pakarinen, MD, PhDa, Johanna Natunen, MDb, Merja Ashorn, MD, PhDc, Antti Koivusalo, MD, PhDa, Pieta Turunen, BMedc, Risto J. Rintala, MD, PhDa and Kaija-Leena Kolho, MD, PhDb

a Sections of Pediatric Surgery
b Pediatrics, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
c Department of Pediatrics, Tampere University Hospital, Tampere, Finland

OBJECTIVE. Long-term outcomes of restorative proctocolectomy for pediatric-onset ulcerative colitis are unclear.

METHODS. Questionnaires on health outcomes and quality of life were mailed to patients with childhood-onset ulcerative colitis who had undergone proctocolectomy with ileoanal anastomosis in 2 university hospitals between 1985 and 2005. Investigators not involved in the surgical management of the patients approached participants. Matched control children were randomly chosen from the Population Register Centre of Finland.

RESULTS. Fifty-two (66%) patients and 117 (37%) controls responded. After a mean follow-up of 10 years, at least 1 surgical complication had occurred in 39 (75%) patients, and 28 (54%) had undergone reoperation. Only 1 failure of ileoanal anastomosis occurred. Ulcerative colitis had been reclassified as Crohn disease in 6 (12%) patients. Pouchitis occurred in 37 (73%) patients. The median stool frequency was 5 for day and 1 for night, but 46% used medication to control stool frequency. Nighttime soiling was reported by 56% of the patients. The mean overall quality-of-life score, the mean BMI (22 kg/m2 for both), and the number of subjects (aged >20 years) with offspring (14% vs 15%) was similar to the population-based controls.

CONCLUSIONS. Stool frequency after restorative proctocolectomy in children with ulcerative colitis is stable and comparable to those of adult patients. Although nighttime incontinence is common, general health status and overall quality of life are comparable to the normal population.

Key Words: children • functional outcome • ileoanal anastomosis • proctocolectomy • ulcerative colitis • quality of life

Abbreviations: UC—ulcerative colitis

Accepted Sep 9, 2008.


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