The satisfaction gained from taking a child from a state of misery and malnutrition to "he is doing so wonderfully after his colon came out" is only tempered by the conversation that must follow. Asking a child and their parents to choose between too evils (multiple bowel movements/incontinence vs the risk of pouch complications/pouchitis) when discussing the next step can only be made more palatable when we have some outcome data to share.
A paper by Seetharamaiah et al in published in JPS in 2009 provided that data.
The authors retrospectively looked at 203 children (average age 15 years) who underwent either a straight ileo anal pull through vs a pouch anastomosis for UC or familial polyposis. The authors compared several outcome variables, including the rate of complications (pouchitis/enteritis) and long term bowel functions as reflected by the modified Hoschneider scoring system (incorporates number/consistency of stool, risk of daytime/nighttime incontinence, severity of urgency, and need for therapy for stool control).
The authors noted that, as one would expect, the patients who underwent a straight pull through had more BM's per day than those who underwent a pouch anastomosis. Interestingly, after 24 months, the number of bowel movements approached that of patients who underwent a pouch anastomosis (mean number of bowel movements for straight pull through vs. pouch anastomosis were 8 vs 6 per day, respectively).
As to the general quality of bowel function, both groups eventually scored similarly on the modified Holschneider coring system, and ultimately ~90% became totally continent after 24 months, regardless of type of operation.
As to pouchitis, the nagging complication of pouch creation, the authors noted that patients had a 49% risk of documented pouchitis, vs 24% risk of ileitis, the counterpart in a patient with a straight pull through.
Based on this data, it appears that both options area reasonable, with the benefit of a better outcome in terms of bowel function for the first two years, when a pouch is created, balanced against the increased risk of pouchitis and what is entails in terms of pain/discomfort, need for antibiotics, and potentially hospital admissions.
A paper by Seetharamaiah et al in published in JPS in 2009 provided that data.
The authors retrospectively looked at 203 children (average age 15 years) who underwent either a straight ileo anal pull through vs a pouch anastomosis for UC or familial polyposis. The authors compared several outcome variables, including the rate of complications (pouchitis/enteritis) and long term bowel functions as reflected by the modified Hoschneider scoring system (incorporates number/consistency of stool, risk of daytime/nighttime incontinence, severity of urgency, and need for therapy for stool control).
The authors noted that, as one would expect, the patients who underwent a straight pull through had more BM's per day than those who underwent a pouch anastomosis. Interestingly, after 24 months, the number of bowel movements approached that of patients who underwent a pouch anastomosis (mean number of bowel movements for straight pull through vs. pouch anastomosis were 8 vs 6 per day, respectively).
As to the general quality of bowel function, both groups eventually scored similarly on the modified Holschneider coring system, and ultimately ~90% became totally continent after 24 months, regardless of type of operation.
As to pouchitis, the nagging complication of pouch creation, the authors noted that patients had a 49% risk of documented pouchitis, vs 24% risk of ileitis, the counterpart in a patient with a straight pull through.
Based on this data, it appears that both options area reasonable, with the benefit of a better outcome in terms of bowel function for the first two years, when a pouch is created, balanced against the increased risk of pouchitis and what is entails in terms of pain/discomfort, need for antibiotics, and potentially hospital admissions.
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