ORIGINAL ARTICLE

Surgical management of inflammatory bowel disease

M E Ba’ath, M W Mahmalat, P Kapur, N P Smith, A M Dalzell, D H Casson, G L Lamont, C T Baillie

Department of Paediatric Surgery, Royal Liverpool Children’s Hospital NHS Trust, Liverpool, UK

Correspondence to:
MrC T Baillie
Department of Paediatric Surgery, Royal Liverpool Children’s Hospital NHS Trust, Eaton Road, Liverpool L12 2AP, UK; colin.baillie{at}rlc.nhs.uk

Aim: To evaluate the outcome and morbidity after major surgical interventions for inflammatory bowel disease (IBD).

Methods: Retrospective case note analysis of 227 children referred to a tertiary referral centre between 1994 and 2002 for treatment of IBD.

Results: 26 of 125 children with Crohn’s disease (21%) required surgical management. 13 with disease proximal to the left colon underwent limited segmental resections and primary anastomosis, without significant morbidity. Primary surgery for 13 children with disease distal to the transverse colon included 6 subtotal-colectomies or panprocto-colectomies. All seven children undergoing conservative segmental resections (three with primary anastomosis, four with stoma formation), required further colonic resection or defunctioning stoma formation. All three children undergoing primary anastomosis developed a leak or fistula formation. 22 of 102 children with ulcerative colitis (22%) required surgery. Definitive procedures (n = 17) included J-pouch ileoanal anastomosis (n = 11), ileorectal anastomosis (n = 2), straight ileoanal anastomosis (n = 3), and proctectomy/ileostomy (n = 1). Five children await restorative surgery after subtotal colectomy. Median daily stool frequency after J-pouch surgery was 5 (range 3–15), and 10 of 11 children reported full daytime continence. All three children with straight ileoanal anastomosis had unacceptable stool frequency and remain diverted.

Conclusion: The complication rate after resectional surgery for IBD was 57% for Crohn’s disease, and 31% for ulcerative colitis. In children with Crohn’s disease, limited resection with primary anastomosis is safe proximal to the left colon. Where surgery is indicated for disease distal to the transverse colon, subtotal or panproctocolectomy is indicated, and an anastomosis should be avoided. Children with ulcerative colitis had a good functional outcome after J-pouch reconstruction. However, the overall failure rate of attempted reconstructive surgery was 24%, largely owing to the poor results of straight ileoanal anastomosis.

Abbreviations: 5-ASA, 5-aminosalicylic acid; IBD, inflammatory bowel disease; IPAA, ileal pouch anal anastomosis; MCR, major colonic resection; SCR, segmental colonic resection; QOL, quality of life

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