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Total intracorporeal laparoscopic resection of Crohn's disease
S Dutta1, S S Rothenberg, J Chang
1Mother and Child Hospital at Presbyterian/St Luke's Hospital, Denver, CO, USA.
Insights
Laparoscopic resection for pediatric Crohn's disease is a safe and effective treatment. This study shows good outcomes with minimal complications in young patients undergoing the procedure.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
- Inflammatory bowel disease
Background:
- Laparoscopic resection benefits are established in adults with Crohn's disease.
- This surgical approach is increasingly applied to pediatric patients.
- The study details the experience with this technique in children.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic resection for Crohn's disease in children.
- To report surgical outcomes and complications in pediatric patients undergoing this procedure.
Main Methods:
- A prospective series of 15 pediatric Crohn's patients (ages 9-17) undergoing laparoscopic ileocolic resection.
- Utilized a 4-port approach with intracorporeal resection and anastomosis.
- Specimen retrieval through a 12-mm port site.
Main Results:
- Average operating time was 110 minutes; average hospital stay was 4 days.
- One patient experienced a minor anastomotic leak, managed conservatively.
- Another patient with a stricture underwent successful laparoscopic revision surgery.
- All patients were symptom-free at follow-up with no major complications.
Conclusions:
- Laparoscopic resection is a safe and effective surgical option for pediatric Crohn's disease.
- The procedure demonstrates favorable outcomes and a low complication rate in this age group.
Background/Purpose:
The benefits of laparoscopic resection for Crohn's disease have been well established in the adult literature. This modality more recently has been applied to children. The authors report their experience in this age group.
Methods:
A prospective series of all pediatric Crohn's patients treated laparoscopically in one surgical practice was studied for demographic data, operative details, and outcome.
Results:
Fifteen patients with diagnosis of Crohn's disease, ages 9 to 17 years, underwent laparoscopic ileocolic resection between February of 1998 and 2002. Patients' weights ranged from 42 to 80 kg. All patients had fixed strictures involving the terminal ileum and ileocecal valve and had failed medical therapy. A 4-port approach (one 12-mm and 3 5-mm) was utilized in all cases. Resection and anastomosis was performed intracorporeally, and the specimen was retrieved through the 12-mm port site. The average operating time was 110 minutes (range, 90 to 180 minutes). Oral feedings were started after 24 hours of nasogastric suction. Hospital stay averaged 4 days (range, 3 to 8 days). One patient had a fever on postoperative day 3. Contrast study showed a small anastomotic leak with no associated collection, and the patient responded to conservative management. One other patient whose pathologic diagnosis questioned the initial Crohn's diagnosis presented with an anastomotic stricture and underwent redo resection laparoscopically with good outcome. No other complications were noted, and all patients were symptom free at follow-up.
Conclusions:
Laparoscopic resection of Crohn's disease in children is safe and effective.
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