The Pediatric Pouch in Inflammatory Bowel Disease

A Primer for the Gastroenterologist

Ghassan T Wahbeh; David L Suskind; Scott D Lee; John T Waldhausen; Karen F Murray

Disclosures

Expert Rev Gastroenterol Hepatol. 2013;7(3):215-223. 

In This Article

Surgical Considerations: Should All Children Receive a Pouch After Colectomy?

The surgical options after colectomy are permanent ileostomy or restoring bowel continuity with an ileoanal (straight) anastomosis (IAA) or an ileal pouch–anal anastomosis (IPAA), also termed restorative proctocolectomy. It is important that the child and family spend sufficient time with the surgery team, including a stoma nurse, to understand the surgical options and postsurgical expectations. Ample information resources should be provided as early in the process as possible. A comprehensive patient and family guide is available through the United Ostomy Associations of America.[101] In addition, we have found that having the patient and family communicate directly with patients and families who have had the surgery can be extremely valuable. The decision to proceed with a colectomy in the first place is understandably quite difficult, more so in the patient who is not critically ill or hospitalized. The decision of which surgery to choose is a different challenge, as it commits the child/adolescent and parent to a new lifelong reality, either with bowel continuity (and its challenges) or permanent ileostomy (and its change in body image and social implications). It is particularly important to involve the adolescent patient in this decision. Anecdotally, we have noted that generally the patient's and parent's decisions are in line. However, more knowledge remains to be gleaned about the dynamics of this decision-making process on the parent, child and adolescent's sides.

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