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Laparoscopic ileocecectomy in pediatric patients with Crohn's disease
Carrie A Laituri1, Jason D Fraser, Carissa L Garey
1Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA.
Insights
Laparoscopic ileocecal resection is a safe and effective treatment for children with Crohn's disease refractory to medication. This surgical approach, including single-incision techniques, shows promising outcomes in pediatric patients.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Inflammatory bowel disease
Background:
- Medically refractory ileocecal Crohn's disease typically requires surgical resection with primary anastomosis.
- Laparoscopic resection is established as effective in adults, but data in pediatric populations is limited.
Purpose of the Study:
- To audit the institutional experience with laparoscopic ileocecectomy in pediatric patients with medically refractory ileocecal Crohn's disease.
- To determine the efficacy and safety of this surgical approach in the pediatric population.
Main Methods:
- A retrospective review was conducted of pediatric patients who underwent laparoscopic ileocecal resection for medically refractory Crohn's disease between 2000 and 2009.
- Data collected included patient demographics, indications for surgery, operative approach (standard or single-incision laparoscopic), and postoperative outcomes.
Main Results:
- Thirty pediatric patients (aged 10-18 years) underwent laparoscopic ileocecectomy. Indications included obstruction/stricture, pain, abscess, fistula, perforation, and bleeding.
- No intraoperative or postoperative complications were reported for the 5 single-incision laparoscopic procedures. Overall, postoperative abscesses occurred in two patients on high-dose prednisone.
- Follow-up averaged 14.7 months, with no anastomotic leaks or wound infections observed.
Conclusions:
- Laparoscopic ileocecectomy, encompassing both standard and single-incision approaches, is a safe and effective surgical option for pediatric patients with medically refractory ileocecal Crohn's disease.
- The study supports the use of minimally invasive techniques in managing this challenging pediatric condition.
Introduction:
Definitive management for medically refractory ileocecal Crohn's disease is resection with primary anastomosis. Laparoscopic resection has been demonstrated to be effective in adults. There is a relative paucity of data in the pediatric population. We therefore audited our experience with laparoscopic ileocecectomy in patients with medically refractory ileocecal Crohn's disease to determine its efficacy.
Methods:
We conducted a retrospective review of all pediatric patients who underwent laparoscopic ileocecal resection for medically refractory Crohn's disease at a single institution from 2000 to 2009.
Results:
Thirty patients aged 10-18 years (mean: 15.3 years) with a mean weight of 50 kg (standard deviation: ± 15.5 kg) underwent laparoscopic ileocecectomy for Crohn's disease. Five of these were performed using a single-incision laparoscopic approach. The indications for surgery were obstruction/stricture (21), pain (10), abscess (3), fistula (3), perforation (2), and bleeding (1). Some patient's had multiple indications. There were a total of five abscesses encountered at operation. Eight patients were on total parenteral nutrition at the time of resection. Twenty-five patients (83.3%) were being treated with steroids at operation. The anastomosis was stapled in 26 patients and hand-sewn in 4. Two patients developed a postoperative abscess, and both of them were taking 20 mg of prednisone daily. One patient developed a small bowel obstruction due to a second Crohn's stricture that manifested itself after the more severe downstream obstruction was relieved with ileocecectomy. Of the 5 patients who underwent a single-incision laparoscopic operation, 3 underwent for obstruction/stricture and 2 for perforation. There were no intraoperative or postoperative complications. The patients were followed up for a maximum of 80.7 months (average: 14.7 months; median: 9.7 months). There were no anastomotic leaks or wound infections.
Discussion:
This series demonstrates that laparoscopic ileocecectomy, both single-incision laparoscopic approach and standard laparoscopy, is safe and effective in the setting of medically refractory Crohn's disease in pediatric patients.
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