Introduction: While restorative proctocolectomy (RP) is accepted as the gold standard for adults with ulcerative colitis undergoing surgery, there has been reluctance to put children forward for this procedure because of concern about the health status of children with a pelvic pouch. The aim of this study is to quantify the general health of a group of children who have undergone RP using a validated health questionnaire.
Methods: 13 children, 8 girls, average age 13, with a minimum of 4 months follow up after RP completed the SF-36 questionnaire, which uses 36 questions to measure 8 variables: physical functioning (PF), role limitation due to physical problems (RP), body pain (BP), general health (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE) and mental health (MH). Children were interviewed independent of the surgical team and answers checked and additional bowel specific questions asked. Scores were compared with published values of adolescents with a straight ileo-anal anastamosis (IA) and English children with cystic fibrosis (CF) and normal controls (NC). Statistical comparison utilised t-test.
Results: Mean% (SD)
Category |
RP |
IA |
CF |
NC |
PF |
88 (9) |
97 (7)* |
78 (23)* |
92 (12) |
RP |
69 (38) |
86 (31) |
79 (28) |
84 (25) |
BP |
71 (20) |
86 (18)* |
87 (19)* |
77 (23) |
GH |
59 (23) |
73 (25) |
48 (24) |
72 (16) |
VT |
58 (19) |
61 (24) |
62 (23) |
56 (17) |
SF |
81 (16) |
79 (25) |
84 (23) |
79 (23) |
RE |
87 (29) |
88 (24) |
78 (23) |
74 (24) |
MH |
74 (17) |
71 (22) |
77 (15) |
70 (18) |
*p<0.05 vs. study group, otherwise ns.
The pouch group scored significantly worse than the straight ileo-anal group in the PF and BP domains, and the CF group in the BP domain, but better than the CF group in PF.
Conclusions: Contrary to most paediatric opinion, the health of children who have received a pelvic pouch is remarkably good, and is statistically indistinguishable from normal control children. The differences seen between the study group and the IA group may reflect longer time since surgery in the IA group. The comparison with children with chronic disease (CF) suggests that children with a pan-colitis who cannot be brought into remission, currently managed with steroid administration would enjoy better health if offered RP in addition to being freed from their disease and steroid toxicity.
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