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Radiofrequency ablation and plication--a new technique for prolapsing hemorrhoidal disease.

BACKGROUND: The author describes a modified procedure of ablation with a radiofrequency device and plication of the hemorrhoidal mass for prolapsing hemorrhoids. The study is aimed at ascertaining if this procedure provides any advantages over the conventional hemorrhoid surgery. MATERIALS AND METHODS: Two different studies are included. The first study describes 600 serial patients with prolapsing hemorrhoids treated with this technique over a period of 18 months. An Ellman radiofrequency generator was used for the ablation of the hemorrhoids. The operative technique and postoperative outcome is reported. The second study compares this technique with standard Milligan-Morgan hemorrhoidectomy in a randomized trial of 100 patients. RESULTS: With this new procedure, the post-defecation pain and pain at rest were within tolerable limits (pain scores 1 to 4 on visual analog scale). Post-defecation bleeding was present in 60% of the patients. Pruritus and perianal thrombosis were complained by few others. No patient encountered any incontinence, prolapse, or stenosis. The comparative study showed definite advantages of this modified technique over Milligan-Morgan hemorrhoidectomy. CONCLUSION: The procedure of radiofrequency ablation and plication of hemorrhoids restricts the hospital stay to only a few hours and provides rapid physical recovery. It does seem to be a better alternative to the conventional surgical procedures in terms of postoperative pain, return to work, and complications.

Adult↗
PubMed2005

Case report: colonic manometry reveals abnormal propulsive behaviour after anterior resection of the rectum.

Anterior resection of the rectum is a frequent surgical procedure. However, abnormal bowel habits following this procedure are frequently reported. The functional evaluation of these patients is usually limited to the anorectal area. By means of colonic manometry, we have evaluated a patient with frequent urge for defecation and increased bowel frequency following anterior resection of the rectum with straight coloanal anastomosis and almost normal anorectal function. Analysis of the tracing revealed a reduction of contractile segmental activity and much more high-amplitude propagated contractions than which occur in healthy subjects. These high-amplitude propagated contractions, representing the manometric equivalent of mass movements, were always in association with urge for defecation and, sometimes, with loose stools. High-amplitude simultaneous contractions were also observed. We feel that the surgical resection of a potential physiological brake may be responsible for these observations.

Aged↗
PubMed2006

5-HT1A receptor agonist affects fear conditioning through stimulations of the postsynaptic 5-HT1A receptors in the hippocampus and amygdala.

Evidence from preclinical and clinical studies has shown that 5-HT(1A) receptor agonists have anxiolytic actions. The anxiolytic actions of 5-HT(1A) receptor agonists have been tested by our previous studies using fear conditioning. However, little is known about the brain regions of anxiolytic actions of 5-HT(1A) receptor agonists in this paradigm. In the present study, we investigated the effects of bilateral microinjections of flesinoxan, a selective 5-HT(1A) receptor agonist, into the hippocampus, amygdala and medial prefrontal cortex on the expression of contextual conditioned freezing and the defecation induced by conditioned fear stress in rats. These results reveal that both intrahippocampal and intraamygdala injections of flesinoxan decreased the expression of conditioned freezing, while injections into the medial prefrontal cortex did not. In addition, intraamygdala injection of flesinoxan attenuated the increased defecation induced by conditioned fear, but injections into the hippocampus and medial prefrontal cortex failed. These results suggest that flesinoxan exerts its anxiolytic actions in the fear conditioning through stimulations of the postsynaptic 5-HT(1A) receptors in the hippocampus and amygdala.

Amygdala↗
PubMed2007

Coccygeal movement: assessment with dynamic MRI.

PURPOSE: Chronic coccygodynia is a difficult problem diagnostically and therapeutically. Moreover, there is no deep knowledge especially in the field of imaging of chronic coccygodynia. In this study several possible measurements are proposed, which all are able to demonstrate coccygeal movement during defecation, in order to assess coccygeal mobility using dynamic MRI during maximum contraction and during straining-evacuation. MATERIALS AND METHODS: A dynamic MRI study of the pelvic floor was performed in 112 patients. Five methods of measurement were assessed. Coccygeal movements were determined through the evaluation of three angles pair and two different distances measured during the phase of maximum contraction and during the phase of straining-evacuation. Results were compared according to age, sex, parity and experience of minor trauma. No patient included in the study had coccygodynia. Measurements taken by two radiologist were compared to determine interobserver agreement. RESULTS: The maximum measurement values of the two distances are homogeneous, between 9 and 9.4mm. The maximum measurement values of the three angles showed a difference that is between 21 degrees and 38 degrees . Two of three angles showed a major measurement values in the funtional texts. In only one patient the coccyx was not mobile. CONCLUSION: Our dynamic MRI study indicates that the coccyx is mobile during defecation and that it is possible to demonstrate coccygeal excursions by assessing the difference between its positions at maximum contraction and during straining-evacuation. The measurement methods used in this study for evaluating coccygeal movements resulted in variably sized observed differences, but all yielded statistically significant results in demonstrating coccygeal excursion. Among the five measurement methods, two resulted in the largest differences. Our data indicate no correlation between coccygeal movements and age, sex, parity, minor trauma and coccygodynia.

Adult↗
PubMed2005

Toward a definition of a threshold for harmless doses to the anal-sphincter region and the rectum.

PURPOSE: To investigate dysfunction caused by unwanted radiation to the anal-sphincter region and the rectum. METHODS AND MATERIALS: A questionnaire assessing bowel symptoms, sexual function, and urinary symptoms was sent to 72 patients with clinically localized prostatic adenocarcinoma treated by external beam radiation therapy at the Radiumhemmet, Karolinska Hospital, in Stockholm, Sweden, 2-4 years after treatment. The mean percentage dose-volume histograms for patients with and without the specific symptom were calculated. RESULTS: Of the 65 patients providing information, 9 reported fecal leakage, 10 blood and mucus in stools, 10 defecation urgency, and 7 diarrhea or loose stools. None of the 19 and 13 patients who received, respectively, a dose of > or =35 Gy to < or =60% or > or =40 Gy to < or =40% of the anal-sphincter region volume reported fecal leakage (p < 0.05). In dose-volume histograms, a statistically significant correlation was found between radiation to the anal-sphincter region and the risk of fecal leakage in the interval 45-55 Gy. There was also a statistically significant correlation between radiation to the rectum and the risk of defecation urgency and diarrhea or loose stools in the interval 25-42 Gy. No relationship was found between anatomic rectal wall volume and the investigated late effects. CONCLUSIONS: Although the limited data in this study prevent the definition of a conclusive threshold regarding volume and dose to the anal-sphincter region and untoward morbidity, it seems that careful monitoring of unnecessary irradiation to this area should be done because it can potentially help reduce the risk of adverse effects, such as fecal leakage. Future studies should pay more attention to the anal-sphincter region and help to more rigorously define its radiotherapeutic tolerance.

Aged↗
PubMed2005

Radiofrequency ablation and plication: a non-resectional therapy for advanced hemorrhoids.

BACKGROUND: Radio frequency ablation followed by plication of the hemorrhoidal mass for patients who would otherwise require hemorrhoidectomy is being practiced at our hospital since last 5 years. This procedure accomplishes hemorrhoidal symptom relief with far less post-operative pain and other complications as compared to various other types of hemorrhoidectomies. MATERIALS AND METHODS: A retrospective study of 1000 patients having grade III or grade IV hemorrhoids treated with the above technique over a period of 30 months is reported. A Ellman radiofrequency generator was used for ablation of the hemorrhoids. Follow-up record of these patients is presented. The post-operative outcome and procedure related complications are compared with conventional hemorrhoidectomy procedures. RESULTS: With this procedure, the post-defecation pain score reported was between 1 and 4 (VAS) in the first week, which subsided thereafter. There were 42% patients who had post-defecation bleeding in the first 10 days. There were 82% patients able to resume duties on the 6th post-operative day. Of these, 5% of the patients had post-operative urinary retention needing catheterization for a single time, and 18 patients required readmission for secondary bleeding. None of the patients complained of fecal incontinence, sepsis, or anal stenosis. In the subsequent follow-up at a mean of 19 months, 4% of the patients had residual skin tags, 3% of them had symptomatic anal papillae, and 2% developed recurrence of hemorrhoids. CONCLUSION: The combined procedure described above could be a feasible alternative for surgical treatment of hemorrhoids being quick and easy to perform. With this procedure, the hospital stay is short, post-operative pain is less, return to work is faster, and recurrence rate is low.

Adult↗
PubMed2004

Weekly administration of irinotecan (CPT-11) plus cisplatin for refractory or relapsed small cell lung cancer.

PURPOSE: Weekly administrations of CPT-11 plus cisplatin together with an anti-diarrheal program, the Oral Alkalization and Control of Defecation [Int J Cancer 1999;83:491; Int J Cancer 2001;92:269; Cancer Res 2002;62:179], were evaluated in this phase II study for patients with refractory or relapsed small cell lung cancer. METHODS: Patients were treated by weekly administrations of 60 mg/m(2) CPT-11 plus 30 mg/m(2) cisplatin on Days 1, 8 and 15 over 4 weeks. Coinciding with the infusions and for 4 days thereafter, the anti-diarrheal program was practiced using orally administered sodium bicarbonate, magnesium oxide and basic water. RESULTS: Twenty-five patients who had prior treatments of etoposide and platinum containing regimens (16 refractory patients and nine relapsed patients) were entered. The mean dose-intensities of CPT-11 and cisplatin were 154.8 and 77.4 mg/m(2) per course, respectively. Therefore, 86% of the planned dose was delivered. There were 20 partial responses and an overall response rate of 80% (95% confidence interval, 62-96%) was obtained. The median time to progression and the median survival after starting this regimen were 3.6 and 7.9 months, respectively. The major toxicity was myelosuppression. Grades 3 and 4 neutropenia occurred in 24 and 12% of patients, respectively. One patient with febrile neutropenia was experienced, and Grade 3 diarrhea was observed in 8%. But there was no treatment death. CONCLUSION: Weekly administrations of CPT-11 plus cisplatin together with Oral Alkalization and Control of Defecation provide a practical and well tolerated regimen that was active for refractory or relapsed small cell lung cancer.

Aged↗
PubMed2005

Functional specializations within the tectum defense systems of the rat.

Here we review the differential contribution of the periaqueductal gray matter (PAG) and superior colliculus (SC) to the generation of rat defensive behaviors. The results of studies involving sine-wave and rectangular pulse electrical stimulation and chemical (NMDA) stimulation are summarized. Stimulation of SC and PAG produced freezing and flight behaviors along with exophthalmus (fully opened bulged eyes), micturition and defecation. The columnar organization of the PAG was evident in the results obtained. Defecation was elicited primarily by lateral PAG stimulation, while the remaining defensive behaviors were similarly elicited by lateral and dorsolateral PAG stimulation, although with the lowest thresholds in the dorsolateral column. Conversely, the ventrolateral PAG did not appear to participate in unconditioned defensive behaviors, which were only elicited by high intensity stimulation likely to encroach on adjacent regions. In the SC, the most important differences relative to the PAG were the lack of stimulation-evoked jumping in both intermediate and deep layers, and of NMDA-evoked galloping in intermediate layers. Therefore, we conclude that the SC may be only involved in the increased attentiveness (exophthalmus, immobility) and restlessness (trotting) of prey species exposed to the cues of a nearby predator. These responses may be distinct from the full-blown flight reaction that is mediated by the dorsolateral and lateral PAG. However, other evidences suggest the possible influences of stimulation schedule, environment dimensions and rat strain in determining outcomes. Overall our results suggest a dynamically organized representation of defensive behaviors in the midbrain tectum.

Animals↗
PubMed2004

Organization of single components of defensive behaviors within distinct columns of periaqueductal gray matter of the rat: role of N-methyl-D-aspartic acid glutamate receptors.

The periaqueductal gray matter (PAG) is functionally organized in longitudinal columns arranged along the aqueduct. Stimulation of lateral and dorsal columns produces a complex set of unconditioned behaviors named the 'defense reaction.' Overt responses in rats comprise a tense immobile display, fully opened eyes (herein named exophthalmus), trotting, galloping, jumping, micturition and defecation. Besides, the PAG is rich in glutamate and respective receptors, including the N-methyl-d-aspartic acid (NMDA) type. Therefore, the present study employed regression analysis to map out electrically and NMDA-induced single components of defensive behaviors produced by stepwise increasing stimulation of PAG. Data confirmed the defensive nature of PAG-evoked responses. Neither the appetitive, nor offensive, mouse-killing or male reproductive behaviors were produced by stimulation of PAG in presence of appropriate targets. Threshold and dose-response logistic analyses largely corroborated the columnar organization of PAG-evoked responses. Thus, whereas the defecation was restricted to PAG lateral column, exophthalmus, micturition and somatic defensive responses were similarly organized in dorsolateral and lateral, but not in the ventrolateral column. Moreover, thresholds of dorsolateral and lateral repertoires were strictly hierarchical, with exophthalmus, immobility, trotting, galloping and jumping appearing in this very order. However, the defensive responses of PAG dorsolateral column required NMDA doses significantly lower than those of lateral PAG. Accordingly, NMDA receptors within the dorsolateral PAG are likely to play a major role in the initiation of PAG-evoked defensive responses. In contrast, the present data do not support the organization of unconditioned defensive behaviors in ventrolateral PAG. The neuroanatomical substrate of each response and the role of PAG and NMDA receptors are discussed in relation to the present data. Further, this is the first report on PAG columnar organization of single components of defensive behaviors.

Animals↗
PubMed2005

Fornix, medial prefrontal cortex, nucleus accumbens, and mediodorsal thalamic nucleus: roles in a fear-based context discrimination task.

The goal of the present study was to evaluate the contributions of various brain structures anatomically and functionally linked to the hippocampus and amygdala in a fear-based context discrimination task. The brain areas of interest included the fornix, medial prefrontal cortex, mediodorsal (MD) thalamic nucleus, and nucleus accumbens. Damage to the MD thalamic nucleus and medial prefrontal cortex produced the largest impairment in context-specific fear responses. Damage to the fornix impaired some fear responses (freezing, ultrasonic vocalizations, defecation, and approach/avoidance) while leaving conditioned fear expression of heart rate and urination unaltered. Damage to the nucleus accumbens was also coupled with deficits in the discriminative expression of some (heart rate, urination, and ultrasonic vocalizations) but sparing of context-appropriate freezing, defecation, and approach/avoidance behaviors.

Analysis of Variance↗
PubMed2006

Validation of a behavioral observation tool to assess pig welfare.

Accurately measuring and monitoring of animal behavior is an important factor when assessing on-farm animal welfare. First we developed a feasible and simple method aiming at consistently on-farm measuring of pig's behavior. This test should cover a broad range of welfare-related pig behavior. The reaction towards a novel object, startling, tail and ear biting, play and aggressive behavior, stereotypies, coughing, sneezing, skin lesions, defecation, urination and cleanliness of body and pen are included. The development of accurate measures of on-farm behavior first requires the reliability assessment of the procedure. Therefore, the methodology was tested in a first part by three observers scoring simultaneously and independently pre-defined behavioral characteristics of 108 group-housed fattening pigs. The inter-observer repeatability of the measures was calculated using intraclass correlation coefficients, which ranged from 0.7 to 1. In a second part, the objective was to validate the behavioral characteristics against salivary cortisol, urinary epinephrine and norepinephrine and production traits. Salivary cortisol concentrations significantly increased in ear-bitten pigs and in pigs with tail lesions. Growth rate significantly dropped when cortisol levels rose. An age effect was also found. The percentage of animals approaching the novel object is positively correlated with the urinary epinephrine concentration. Pigs defecating during the test showed significantly higher epinephrine levels. Urinary norepinephrine concentration decreased significantly with age. Faster growing animals and animals with tail lesions showed significantly higher levels of norepinephrine. Pen dirtiness and number of animals per pen were associated with higher norepinephrine concentrations. Finally, barrows had higher norepinephrine concentrations than sows.

Adrenocorticotropic Hormone↗
PubMed2005

Achieving the 'good life': why some people want latrines in rural Benin.

Nearly half the world's population lacks basic sanitation to protect their environment from human fecal contamination. Building a latrine is the first step on the sanitation ladder in developing countries where a majority of the population defecates in open or public areas. Public health programs to improve sanitation have consistently framed promotional messages in terms of fecal-oral disease prevention and largely fail to motivate changes in sanitation behavior. A qualitative consumer study using in-depth interviews with 40 household heads was carried out to explore the decision to install a pit latrine in rural Benin. The motives for installing a latrine are reported and variations across the interviews are examined. The paper asserts that at least one active drive (desire for change or dissatisfaction) from among 11 found is needed to motivate latrine adoption. Drives involved prestige, well-being, and situational goals. Health considerations played only a minor role, and had little if anything to do with preventing fecal-oral disease transmission. Drives varied with gender, occupation, life stage, travel experience, education, and wealth, and reflected perceptions of the physical and social geography of the village, linked to availability of open defecation sites, social structure, road access, and urban proximity. The results have broad implications for new messages and strategies to promote sanitation in developing countries.

Adult↗
PubMed2002

Ascaris lumbricoides among children in rural communities in the Northern Area, Pakistan: prevalence, intensity, and associated socio-cultural and behavioral risk factors.

The prevalence and intensity of Ascaris lumbricoides in 492 children from five rural villages in the Northern Area of Pakistan was examined. The overall prevalence of A. lumbricoides was 91% (95%CI 88.6-93.6) with geometric mean (GM) egg count intensities of 3985 eggs per g (epg). The most intense A. lumbricoides infections were found in children aged 5-8 years. We also investigated selected socio-cultural and behavioral variables for A. lumbricoides infections that might be relevant for the design of appropriate prevention and control programs. Univariate analysis associated A. lumbricoides intensity with age (P=0.004), location of household (P<0.01), defecation practices (P=0.02), soil eating habit (P<0.01), hand washing after defecation (P<0.01), and living with children under 5 years old (P=0.02). Multivariate analysis identified the children's age 5-8 (P<0.01), location of household in Surngo, Askole, and Stakchun where the pilot health care model activities were not done (P<0.01), and living with children under 5 years old (P=0.03) as variables statistically associated with the intensity of A. lumbricoides. The results indicated that there were certain clear risk factors in A. lumbricoides transmission, and that its intensity was influenced by age-related behavioral and environmental factors that contribute to exposure.

Animals↗
PubMed1999

Outcome after rectovaginal fascia reattachment for rectocele repair.

OBJECTIVE: This study was undertaken to determine the effects of rectovaginal fascia reattachment on symptoms and vaginal topography. STUDY DESIGN: Standardized preoperative and postoperative assessments of vaginal topography (the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons) and 5 symptoms commonly attributed to rectocele were used to evaluate 66 women who underwent rectovaginal fascia reattachment for rectocele repair. All patients had abnormal fluoroscopic results with objective rectocele formation. RESULTS: Seventy percent (n = 46) of the women were objectively assessed at 1 year. Preoperative symptoms included the following: protrusion, 85% (n = 39); difficult defecation, 52% (n = 24); constipation, 46% (n = 21); dyspareunia, 26% (n = 12); and manual evacuation, 24% (n = 11). Posterior vaginal topography was considered abnormal in all patients with a mean Ap point (a point located in the midline of the posterior vaginal wall 3 cm proximal to the hymen) value of -0.5 cm (range, -2 to 3 cm). Postoperative symptom resolution was as follows: protrusion, 90% (35/39; P <.0005); difficult defecation, 54% (14/24; P <.0005); constipation, 43% (9/21; P =.02); dyspareunia, 92% (11/12; P =.01); and manual evacuation, 36% (4/11; P =.125). Vaginal topography at 1 year was improved, with a mean Ap point value of -2 cm (range, -3 to 2 cm). CONCLUSION: This technique of rectocele repair improves vaginal topography and alleviates 3 symptoms commonly attributed to rectoceles. It is relatively ineffective for relief of manual evacuation, and constipation is variably decreased.

Adult↗
PubMed2003

Intraperitoneal corticotropin-releasing factor and urocortin induce Fos expression in brain and spinal autonomic nuclei and long lasting stimulation of colonic motility in rats.

CRF injected intraperitoneally (i.p.) stimulates colonic motor function and induces Fos expression in colonic myenteric neurons. We investigated central and spinal Fos expression and changes in colonic motility in response to i.p. injection of CRF and urocortin. Ovine CRF(9-33) that is devoid of intrinsic activity at the CRF receptors, was used as control peptide. Myoelectrical activity was monitored for 1 h before and after peptide injection (10 microg/kg, i.p.) in conscious non fasted rats with chronically implanted intraparietal electrodes in the cecum and proximal colon. Brain and lumbosacral spinal cord were processed for Fos immunohistochemistry at 1 h postinjection. CRF and urocortin elicited defecation and a new pattern of ceco-colonic clustered spike bursts that peaked within 15 min and lasted for the 1 h experimental period while CRF(9-33) did not modify baseline myoelectrical activity and defecation. CRF increased significantly Fos expression in the central nucleus of the amygdala (lateral part), parabrachial nucleus (external lateral subnucleus), area postrema, nucleus tractus solitarius, locus coeruleus, paraventricular nucleus of the hypothalamus, the intermediolateral column and area I-VII, X at the L6-S1 level of the spinal cord by 11-, 6.5-, 5.3-, 5.0-, 4.7-, 2.7- and 1.4-fold, respectively compared with i.p. CRF(9-33) injected rats that had little Fos expression. Urocortin induced a similar pattern of Fos response in the brain and the spinal cord. These results indicate that i.p. CRF and urocortin induce a peptide specific activation of brain nuclei receiving viscerosensory inputs and involved in autonomic circuitries whose effector limbs may impact on visceral function.

Animals↗
PubMed2000

Prolonged ambulatory colonic manometric studies using endoclips.

BACKGROUND: It is difficult to study human colonic motility under physiologic conditions. An important limitation associated with prolonged colonic recording is the failure of the sensors to resist normal expulsive forces. METHOD: In this article we describe a method of endoscopically positioning a manometric catheter by using clips in conjunction with a solid-state catheter. With the use of a rotatable clip-fixing device loaded on to a colonoscope, the manometric catheter was clipped to the colonic mucosa. RESULTS: Recordings for up to 120 hours were obtained from 6 subjects without apparent migration of the catheter assembly. No complications were noted, the catheter does not interfere with defecation, and defecation does not result in its expulsion. CONCLUSION: The current technique will allow reliable ambulatory measurements over prolonged periods of time in relatively comfortable and unrestrained subjects. This technique should increase our understanding of normal and abnormal colonic motility.

Colon↗
PubMed2003

Transanal endorectal pull-through for Hirschsprung's disease: experience with 68 patients.

BACKGROUND/PURPOSE: The aim of this study was to evaluate the indications, results, and complications of transanal endorectal pull-through (TEPT) in the management of recto-sigmoid Hirschsprung's disease (HD). METHODS: Between November 1998 and March 2002, 68 TEPT procedures were performed in infants and children. The patients' ages ranged from 6 days to 13 years. The primary diagnosis in all 68 patients was Hirschsprung's disease confined to the recto-sigmoid region. All children had their operations done without construction of preoperative colostomy except for one. Follow-up period ranged from 3 to 39 months (mean, 21 months). RESULTS: The mean operating time was 90 minutes, and average length of bowel resected was 25 cm. Sixty-two patients had satisfactory results without complications. Blood transfusion was needed in only 11 patients. Recovery was very fast, and patients often were hungry within 24 hours. Feeding was resumed within 48 hours. One patient required laparotomy during the procedure owing to injury to the urethra. Two patients required colostomy 3 and 5 days after surgery respectively, because of delayed leakage. Three patients suffered from attacks of enterocolitis 6 to 9 months postoperatively. There was increased frequency of defecation (5 to 15 times daily) for 4 to 6 weeks after surgery in all the patients. There was no constipation, no incontinence, no cuff abscess, and no mortality in any of the patients. Average frequency of defecation was 1 to 3 times daily after 3 months. The cost of the TEPT technique was almost half that of the open surgery. CONCLUSIONS: TEPT takes less time, has less bleeding, shorter hospital stay, less morbidity, and earlier recovery than similar open pull-through procedures. The hazards and morbidities associated with laparotomy and colostomy may be avoided with a one-stage technique in Hirschsprung's disease confined to the recto-sigmoid region. Careful long-term follow-up is required to assess continence and sexual function.

Child↗
PubMed1996

Restorative proctocolectomy for ulcerative colitis in children--is the J-pouch better than straight pull-through?

Proctocolectomy and ileoanal anastomosis (IAA), with or without an ileal pouch, is the preferred method for the surgical treatment of ulcerative colitis (UC) in children. The authors compared the surgical complications and functional outcome for patients with UC who had proctocolectomy and straight IAA with those of patients who had proctocolectomy and IAA with a J-pouch. Twenty-two children (aged 7 to 15 years) with intractable UC had an IAA, 11 by straight ileoanal anastomosis (SIAA) and 11 with a J-pouch (JIAA). The median clinical and endoscopic follow-up period for SIAA patients was 4 years (range, 3.0 to 6.5 years); for JIAA patients it was 2 years (range, 1 to 3 years). The frequency of daytime and nighttime defecation was significantly higher (P < .03) for patients with SIAA at 3, 6, and 12 months postoperatively. At the last follow-up visit, the mean frequency of defecation for patients with SIAA was 6.1 +/- 2.5/d; that for patients with JIAA was 3.3 +/- 0.5/d (P < .03). Six of 10 patients with SIAA but none with JIAA had nighttime bowel evacuations. None of the patients had daytime soiling; 3 with SIAA and 2 with JIAA had slight soiling during sleep. There was no significant difference in the incidence of early (SIAA 27% v JIAA 45%) and late (SIAA 54% v JIAA 27%) surgical complications between the two groups. Endoscopically confirmed symptomatic pouchitis during the first postoperative year was found in 4 of the 11 (36%) patients with SIAA and in 2 of the 11 (18%) with JIAA (difference not significant). The early and long-term functional results of JIAA are superior to those of SIAA. There is no difference in the incidence of surgical complications and pouchitis between JIAA and SIAA patients.

Adolescent↗