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Single-incision laparoscopic surgery (SILS) for children with Crohn's disease
Justin T Huntington1,2, Laura A Boomer3, Victoria K Pepper3
1Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. justin.huntington@osumc.edu.
Insights
Single-incision laparoscopic surgery (SILS) is a viable option for pediatric Crohn's disease patients, showing similar outcomes to open surgery. With increased experience, operative times for SILS became comparable to open procedures.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Minimally invasive techniques
Background:
- Single-incision laparoscopic surgery (SILS) has gained traction in adult Crohn's disease but remains underutilized in pediatric cases.
- Crohn's disease in children often requires surgical intervention for complications like strictures and obstructions.
Purpose of the Study:
- To evaluate the feasibility and outcomes of SILS for pediatric Crohn's disease patients.
- To compare SILS with traditional open surgery (OS) in this specific population.
Main Methods:
- A retrospective review of pediatric patients with Crohn's disease who underwent small bowel resection or ileocecectomy between 2006 and 2014.
- Data analysis included patient demographics, surgical approach (SILS vs. OS), operative time, length of stay, and postoperative complications.
Main Results:
- The study included 19 patients in the open surgery (OS) group and 41 in the SILS group, with similar demographics and indications for surgery (primarily stricture/obstruction).
- While initial operative times were longer for SILS, they became comparable to OS when analyzing the last 20 SILS cases.
- No significant differences were observed in postoperative length of stay or overall complication rates between SILS and OS.
Conclusions:
- Single-incision laparoscopic surgery (SILS) ileocecectomy is a feasible and safe approach for pediatric Crohn's disease.
- SILS achieves comparable outcomes to open surgery in terms of complications and length of stay.
- Increasing surgical experience with SILS in pediatric Crohn's disease leads to comparable operative times with open surgery.
Purpose:
Single-incision laparoscopic surgery (SILS) has been described in adults with Crohn's disease, but its use in pediatric Crohn's patients has been limited. The purpose of this study was to review our experience with SILS in pediatric patients with Crohn's disease.
Methods:
A retrospective review was performed for patients diagnosed with Crohn's disease who underwent small bowel resection or ileocecectomy at a freestanding children's hospital from 2006 to 2014. Data collected included demographic data, interval from diagnosis to surgery, operative time, length of stay, and postoperative outcomes.
Results:
Analysis identified 19 patients who underwent open surgery (OS) and 41 patients who underwent SILS. One patient (2.4 %) within the SILS group required conversion to OS. Demographic characteristics were similar between the 2 cohorts. The most common indication for surgery was stricture/obstruction (SILS 70.7 % vs. OS 68.4 %, p = 0.86), and ileocecectomy was the most common primary procedure performed (SILS 90.2 % vs. OS 100 % OS). Operative times were longer for SILS (135 ± 50 vs. 105 ± 37 min, p = 0.02). However, when the last 20 SILS cases were compared to all OS cases, the difference was no longer statistically significant (SILS 123.3 ± 34.2 vs. OS 105 ± 36.5, p = 0.12). No difference was noted in postoperative length of stay (SILS 6.5 ± 2.2 days vs. OS 7.4 ± 2.2 days, p = 0.16) or overall complication rate (SILS 24.4 % vs. OS 26.3 %, p = 0.16).
Conclusion:
SILS ileocecectomy is feasible in pediatric patients with Crohn's disease, achieving outcomes similar to OS. As experience increased, operative times also became comparable.
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