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Population-based study of surgery in juvenile onset Crohn's disease
D M Sedgwick1, J R Barton, D W Hamer-Hodges
1Gastrointestinal Unit, University of Edinburgh, UK.
Insights
Pediatric Crohn's disease frequently requires surgery, with half of young patients needing major operations within five years of symptom onset. Surgical approaches in children differ from adult data, indicating a need for tailored pediatric care strategies.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes Research
Background:
- Crohn's disease is a chronic inflammatory bowel disease.
- Pediatric onset Crohn's disease presents unique challenges in management and surgical needs.
Purpose of the Study:
- To analyze the surgical history and outcomes of pediatric Crohn's disease patients.
- To compare surgical interventions in children with existing adult surgical audit data.
Main Methods:
- A cohort of 68 children with Crohn's disease was identified from Scottish Hospital In-patient Statistics.
- Surgical histories were analyzed using actuarial methods.
- Operations were compared with the Lothians' Surgical Audit data.
Main Results:
- 54 of 68 patients (79%) underwent surgery, totaling 135 operations (71 major, 64 minor).
- 50% of the cohort had a major operation within 5 years of symptom onset; median time to a second operation was 4 years.
- Juvenile onset patients showed a high rate of exploratory laparotomy (12 cases) compared to adult data. 18% developed a permanent stoma after a mean follow-up of 7 years.
Conclusions:
- Surgical intervention is highly frequent in young patients with Crohn's disease.
- The pattern of major operations in pediatric Crohn's disease differs significantly from adult populations.
- Findings underscore the need for specialized surgical considerations in pediatric Crohn's disease management.
Abstract:
A geographically based cohort of 68 children with Crohn's disease was derived by sampling from Scottish Hospital In-patient Statistics. Surgical histories were examined and analysed by actuarial methods, and the nature of major operations performed was compared with operations for Crohn's disease in the Lothians' Surgical Audit. Fifty-four of the 68 patients were treated surgically, with a total of 135 operations (71 major, 64 minor). Fifty per cent of the cohort had a major operation within 5 years of onset of symptoms; median time to a second operation was 4 years. The types of major operation performed in juvenile onset patients differed significantly from those recorded in the Lothians' audit, with a high rate of exploratory laparotomy in younger patients (12 cases). With a mean follow-up of 7 years, 12 patients (18 per cent) have a permanent stoma. There were five deaths, three postoperative. This study highlights the frequency of surgical intervention in young people with Crohn's disease.