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Resection leads to less recurrence than strictureplasty in a paediatric population with obstructive Crohn's disease

Richard Bamford1, Ashley Hay1, Devinder Kumar1

  • 1Department of General and Colorectal Surgery, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.

Surgery Research and Practice
|November 7, 2014
PubMed

Insights

For obstructive Crohn's disease in children, resection surgery is preferable to strictureplasty. Resection led to fewer subsequent surgeries compared to strictureplasty in this pediatric patient group.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Inflammatory Bowel Disease

Background:

  • Obstructive Crohn's disease in pediatric patients often requires surgical intervention.
  • Strictureplasty preserves bowel length and is preferred in adults, but its efficacy in children is less understood.
  • Surgical options include resection and strictureplasty for managing stenotic segments.

Purpose of the Study:

  • To compare the outcomes of strictureplasty versus resection in children and adolescents with obstructive Crohn's disease.
  • To evaluate postoperative complications and recurrence rates between the two surgical approaches.
  • To determine the optimal surgical strategy for pediatric obstructive Crohn's disease.

Main Methods:

  • A retrospective study included patients under 20 years undergoing surgery for stenotic Crohn's disease over nine years.
  • Patients were divided into two groups: strictureplasty (Group 1) and resection (Group 2).
  • Kaplan-Meier analysis was used to compare postoperative complications and recurrence rates.

Main Results:

  • Forty operations were performed on 26 patients (mean age 15.6 years).
  • Significantly more patients in the strictureplasty group (Group 1) required further surgery compared to the resection group (11/19 vs. 3/21; P = 0.008).
  • Procedures commonly involved the terminal ileum and ileocolic junction.

Conclusions:

  • Resection appears to be a more favorable surgical option than strictureplasty for obstructive Crohn's disease in children and adolescents.
  • The findings suggest that resection may lead to better long-term outcomes with fewer reoperations in this pediatric population.
  • Further research should consider disease duration, severity, and prior treatments when comparing surgical strategies.

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