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Surgery for children with Crohn's disease: indications, complications and outcome
S C Blackburn1, A E Wiskin, C Barnes
1Department of Paediatric Surgery, Southampton University Hospital NHS Trust, , Southampton, UK.
Insights
Surgery for paediatric Crohn's disease has a 22% early complication rate and a 15% risk of relapse, with 21% needing repeat surgery. While BMI improved, height SDS did not change significantly in pediatric Crohn's disease patients undergoing surgery.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease Research
Background:
- Limited outcome data exists for pediatric Crohn's disease surgery.
- This study reports a decade of surgical experience from a regional pediatric gastroenterology center.
Purpose of the Study:
- To evaluate surgical outcomes in children with Crohn's disease.
- To assess complication rates, relapse risks, and anthropometric changes following surgery.
Main Methods:
- Retrospective review of pediatric Crohn's disease patients undergoing surgery between 2002-2012.
- Data collected from patient registers and medical records, with follow-up until transition to adult care.
- Analysis of surgical indications, complications, relapse rates, and changes in height and BMI standard deviation scores (SDS).
Main Results:
- Sixty-nine children (61% male) were included, with a median follow-up of 1.8 years.
- 58 (84%) had intra-abdominal surgery, most commonly for stricturing disease (60%).
- Early complications occurred in 22%, late in 8.6%, and 15% experienced disease relapse, with 21% requiring a second unplanned intra-abdominal procedure. BMI SDS increased significantly (p<0.05), but height SDS did not.
Conclusions:
- Surgery in pediatric Crohn's disease is associated with significant early complication and relapse rates.
- A notable percentage of patients require repeat intra-abdominal procedures.
- Surgical intervention positively impacted BMI SDS but did not improve height SDS in this pediatric cohort.
Background:
Outcome data for surgery in paediatric Crohn's disease are limited. We report 10 years' experience at a regional paediatric gastroenterology centre.
Methods:
Children undergoing surgery for Crohn's disease (January 2002-December 2012) were identified from an onsite patient register. Patients were followed until transition to adult services. Data were obtained from medical records and are expressed as median (range).
Results:
Sixty-nine children, aged 13.8 years (6.3-17.0) at diagnosis, were included. 42 were male (61%). Follow-up was 1.8 years (27 days-6 years). Surgery followed diagnosis by 9 months (0 days-7 years). 52 children (75%) received thiopurines and 5 (7%) anti-TNF (tumour necrosis factor) therapy preoperatively. 58 (84%) underwent intra-abdominal surgery (40 right hemicolectomy, 8 stoma formation, 2 subtotal colectomy, 2 small bowel resection, 6 other) and 10 (14%) underwent surgery for perianal disease. The commonest indications for intra-abdominal surgery were stricturing disease 35 (60%) and unresponsive luminal disease 13 (22%). There were 13 (22%) early, and 5 (8.6%) late, complications following intra-abdominal surgery. Nine children had disease relapse, five required further surgery. Height SD scores (SDS) did not increase between diagnosis; -0.5 (-3.4-2.1) and most recent follow up; -0.4 (-3.0-1.1). Body Mass Index (BMI) SDS increased from -1.0 (-6.3-1.5) to -0.3 (-3.3-2.0) (p<0.05).
Conclusions:
Surgery was associated with a 22% early complication rate and a 15% risk of relapse. 21% of patients required a second unplanned intra-abdominal procedure. Surgical intervention was associated with an increase in BMI SDS, but not in height SDS.
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