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Single surgeon experience with laparoscopic surgery in pediatric patients with inflammatory bowel disease
Renee Huang1, Issam Koleilat, Edward C Lee
1Department of Surgery, Albany Medical Center, Albany, New York 12208, USA.
Insights
Laparoscopic surgery for pediatric inflammatory bowel disease (IBD) is safe and effective, showing acceptable complications and conversion rates. This approach offers potential long-term benefits for children with IBD.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Laparoscopic management of inflammatory bowel disease (IBD) is established in adults.
- Efficacy and safety in pediatric IBD patients are less defined.
Purpose of the Study:
- To review a single surgeon's laparoscopic experience with pediatric IBD patients.
- To assess the safety and efficacy of laparoscopic IBD management in children.
Main Methods:
- Retrospective analysis of pediatric patients (≤17 years) undergoing initial laparoscopic surgery for IBD from May 2002 to May 2011.
- Evaluation of operative time, conversion rates, blood loss, hospitalization, and 30-day outcomes.
Main Results:
- 52 laparoscopic surgeries performed on 44 pediatric patients.
- Mean operative time was 132 minutes; 3.8% conversion rate to open surgery.
- 19.2% postoperative complications, including wound infections and re-admissions.
Conclusions:
- Laparoscopic IBD management is feasible and safe in pediatric patients.
- Acceptable perioperative morbidity and conversion rates were observed.
- This approach may offer long-term benefits for children with IBD.
Purpose:
Laparoscopic management of inflammatory bowel disease (IBD) has been well established in adults. Its efficacy and safety are less defined in pediatrics. We reviewed our single surgeon laparoscopic experience with pediatric IBD patients.
Patients And Methods:
All consecutive patients 17 years old or younger with IBD who underwent initial laparoscopic surgery for management of disease from May 2002 to May 2011 were identified. Patients were analyzed retrospectively with respect to age, gender, weight, American Society of Anesthesiologists classification, history of prior abdominal surgery, operative time, need for conversion to open procedure, estimated blood loss, need for blood transfusion, length of hospitalization, need for intensive care unit monitoring, and patient outcomes within 30 days.
Results:
In total, 44 pediatric patients underwent 52 laparoscopic surgeries. Forty-two patient cases (80.8%) had had no prior abdominal surgery. Mean operative time was 132 minutes. Two patients (3.8%) underwent conversion from a laparoscopic to open approach. Mean estimated blood loss was 64 mL. The average hospitalization was 5.5 days. Postoperative complications occurred in 10 patients (19.2%): 2 were treated for wound infection or abscess, 7 required re-admission, and 1 required return to the operating room for exploratory laparotomy.
Conclusions:
Laparoscopic management of IBD has not routinely been implemented in the pediatric population. We demonstrate acceptable perioperative morbidity and rate of conversion to open with an overall successful laparoscopic approach in pediatric patients. This may have particular long-term benefits in a population faced with longer life expectancy. An initial laparoscopic approach is a feasible and safe option for pediatric IBD patients.
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