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Strictureplasty and intestinal resection: different options in complicated pediatric-onset Crohn disease
Erminia Romeo1, Vincenzo Jasonni, Tamara Caldaro
1Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy. erminia.romeo@gmail.com
Insights
Strictureplasty (SP) and resection are effective surgical options for pediatric Crohn disease (CD) strictures. Long-term outcomes show similar relapse rates, suggesting SP may be preferable for intestinal preservation.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Inflammatory bowel disease research
Background:
- Intestinal strictures are a common complication of pediatric Crohn disease (CD).
- Surgical intervention is often necessary for symptomatic strictures unresponsive to conservative management.
- Resection and strictureplasty (SP) are primary surgical approaches.
Purpose of the Study:
- To compare the long-term outcomes of surgical resection versus strictureplasty (SP) in pediatric patients with Crohn disease (CD).
- To evaluate the efficacy and recurrence rates associated with each surgical technique.
Main Methods:
- Retrospective review of 39 pediatric patients with symptomatic ileal/ileocolonic CD strictures treated between 1996-2011.
- Patients underwent either intestinal resection (Group A, n=20) or various SP techniques (Group B, n=19).
- Mean follow-up duration was 6.88 years.
Main Results:
- Early complications occurred in 2 patients post-resection.
- Late complications in the resection group included adhesions and medical recurrence.
- In the SP group, 3 patients experienced recurrence, with 2 at the surgical site.
Conclusions:
- No significant difference in long-term relapse rates between resection and SP for pediatric CD strictures.
- Both strictureplasty and resection are effective treatments for pediatric CD strictures.
- Strictureplasty may be considered the preferred initial surgical option to maximize intestinal preservation.
Background/Purpose:
Surgical resection or strictureplasty (SP) are different options for intestinal Crohn disease (CD) strictures. The aim of this article is evaluation of long-term outcome of SP and resection.
Methods:
From 1996 to 2011, 39 patients (23 male, 16 female) with symptomatic ileal and ileocolonic CD strictures resistant to medical/nutritional therapy and treated with surgery in 2 different surgical units were reviewed. The mean age at diagnosis was 11.82 years (range, 4-17 years). Mean age at surgery was 15.94 years (range, 4-24 years). Mean follow-up was 6.88 years (range, 0.5-15 years). Patients underwent resection (group A) or different SP techniques (group B).
Results:
Twenty patients underwent intestinal resection (ileal or ileocolonic resection), and 19 patients underwent SP (jejunal, ileal, or ileocolic). Early postsurgical complications were observed in 2 patients of group A. Follow-up of group A patients revealed that 1 patient needed emergency treatment after 8 months surgery because of adhesions and 1 patient developed recurrence treated with medical therapy. In the follow-up group B, 3 patients experienced disease recurrence, 2 of them at the site of previous surgery.
Conclusions:
At long-term follow-up, no significant difference in relapsing rate was observed between the 2 groups. Strictureplasty and resection represent an effective treatment of pediatric CD strictures. Strictureplasty could represent the first option for intestinal preservation.
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