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Outcomes after laparoscopic surgery in children with inflammatory bowel disease
Ivan R Diamond1, J Ted Gerstle, Peter C W Kim
1Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
Insights
Laparoscopic surgery is feasible for pediatric inflammatory bowel disease (IBD) with low conversion rates. However, colorectal procedures show a high rate of late bowel obstruction, similar to open surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease Management
Background:
- The effectiveness of laparoscopic surgery for pediatric inflammatory bowel disease (IBD) remains unclear.
- Laparoscopic approaches offer potential benefits like improved cosmesis.
Purpose of the Study:
- To evaluate the feasibility and outcomes of laparoscopic procedures in children with IBD.
- To compare laparoscopic approach outcomes with traditional open surgery.
Main Methods:
- Retrospective cohort study of pediatric IBD patients undergoing laparoscopic or laparoscopy-assisted surgery.
- Data collected from 1999-2007 at a quaternary pediatric referral center.
Main Results:
- 154 operations performed on 136 children (median age 14.8 years) with Crohn's disease, ulcerative colitis, or indeterminate colitis.
- Low conversion rates for small bowel/ileocolic resections (8.2%) and subtotal colectomy (7.1%).
- High morbidity for colorectal procedures (STC 62.8%, IPAA 63.6%) and a 16% incidence of late bowel obstruction after colorectal surgery.
Conclusions:
- Laparoscopic surgery is a feasible option for pediatric IBD with low conversion rates.
- Perioperative morbidity is comparable to open procedures, despite cosmetic advantages.
- Laparoscopic colorectal IBD surgery is associated with a high incidence of postoperative bowel obstruction.
Background:
The utility and efficacy of the laparoscopic approach to the management of inflammatory bowel disease (IBD) in children are not clearly known.
Methods:
We conducted a retrospective descriptive cohort study of children with a diagnosis of IBD who underwent a laparoscopic or laparoscopy-assisted procedure at a quaternary pediatric referral center between 1999 and 2007.
Results:
One-hundred thirty-six children underwent 154 operations (85 small bowel/ileocolic and 69 colorectal) over the 8 years of the study. Median age was 14.8 years (range = 1.8-18.8). The diagnosis was Crohn's disease in 83, ulcerative colitis in 50, and indeterminate colitis in 3. Median time to regular diet was 5 days (range = 1-19), and median postoperative stay was 7 days (range = 1-70). Seven patients undergoing a small bowel/ileocolic resection (8.2%) were converted to an open procedure. Overall morbidity for the small bowel/ileocolic procedures was 27.1%. The conversion rate during subtotal colectomy (STC) was 7.1% (3/42), and it was 0% for the 22 patients who underwent ileal pouch-anal anastomosis (IPAA) procedures. Overall morbidity associated with STC was 62.8%, and following IPAA it was 63.6%. Sixteen percent (7/69) of those who underwent a colorectal procedure developed a late postoperative bowel obstruction with three patients requiring operative intervention.
Conclusion:
A laparoscopic approach is feasible with a low conversion rate in most children with IBD. Despite superior cosmesis, perioperative morbidity is similar to that seen with open procedures. Laparoscopic colorectal IBD procedures are associated with an unexpectedly high incidence of postoperative bowel obstruction, although the rates are comparable to those seen with open surgery.
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