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The operative management of children with complex perianal Crohn's disease
Natashia M Seemann1, Sebastian K King1, Abdul Elkadri2
1Division of General and Thoracic Surgery, Hospital for Sick Children, Department of Surgery, University of Toronto.
Insights
Complex perianal Crohn's disease (PCD) in children often requires major surgery. This study highlights the challenging nature of complex PCD and the surgical interventions needed for symptom relief in pediatric patients.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Inflammatory bowel disease
Background:
- Perianal Crohn's disease (PCD) significantly impacts pediatric quality of life and psychological well-being.
- A subset of pediatric patients with complex PCD necessitates surgical intervention, but optimal timing and treatment remain unclear.
Purpose of the Study:
- To describe a large pediatric cohort with complex PCD in a tertiary center.
- To determine the range of surgical management strategies for children with complex PCD.
Main Methods:
- Retrospective review of pediatric patients requiring operative intervention for PCD from 2002 to 2014.
- Classification of PCD into simple and complex groups based on surgical procedures.
- Comparison of characteristics and outcomes between simple and complex PCD groups.
Main Results:
- Fifty-seven children were analyzed: 43 in the simple group (abscess drainage ± seton) and 14 in the complex group (loop ileostomy ± extensive surgery).
- Complex PCD patients were predominantly female, diagnosed at a younger age, and all received anti-TNF therapy.
- All 14 complex patients underwent defunctioning ileostomy, with 7 requiring further major operations.
Conclusions:
- Complex PCD constitutes a small yet challenging patient subset.
- Major surgical intervention may be essential for symptom alleviation in pediatric complex PCD.
Background/Purpose:
Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD.
Methods:
A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed. PCD was divided into simple and complex based on the type of surgical procedure, and the two groups were compared.
Results:
The 57 children were divided into two groups: the simple group (N=43) underwent abscess drainage ± seton insertion alone, and the complex group (N=14) underwent loop ileostomy ± more extensive surgery. In the complex group, females were more predominant (57% of complex vs 30% of simple), and the average age at diagnosis was lower. Anti-TNF therapy was utilized in 79.1% of simple and 100% of complex PCD. All 14 complex patients underwent a defunctioning ileostomy, with 7 requiring further operations (subtotal colectomy=4, proctocolectomy ± anal sparing=5, plastic surgery reconstruction with perineal flap/graft=4).
Conclusion:
Complex PCD represents a small but challenging subset of patients in which major surgical intervention may be necessary to alleviate the symptoms of this debilitating condition.
Level Of Evidence:
retrospective case study with no control group - level IV.
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