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The short answer to this is anyone who has lost their colon and rectum but who wishes to defaecate through their anus rather than through a permanent ileostomy. However, the choices are slightly more complex!The easiest group are children with a disease called ulcerative colitis, but even among these children it can be difficult to recognise when treatment with drugs has failed and surgery is needed. The mainstay of medical treatment consists of suppresion of the disease with steroids, but the side effects of these can be more damaging than the disease, and can themselves be an indication for surgery. My criteria for surgery are failure of medical therapy to induce a sustained remission from disease. The next group are children with a genetic disease called familial adenomatous polyposis. This disease invariably progresses to colonic cancer, and regrettably there have been cases of cancer in children. I believe that whenever colonoscopy reveals more than 20 polyps it is no longer possible to be certain about the disease progression in all polyps and it is safer to remove the colon. We have experience of using this operation for other groups of children, including children with cystic fibrosis whose colon has been irreversibly damaged by the treatment with enzymes. We have also treated a small number of children with intractable constipation with this operation. |
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