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Colectomy in refractory Crohn's colitis improves nutrition and reduces steroid use
Aodhnait S Fahy1, D Dean Potter1, Anupama Ravi2
1Division of Pediatric Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Insights
Total colectomy (TC) in pediatric Crohn's colitis (CC) improves nutrition and growth. This surgery offers a good chance for restoring intestinal continuity, unlike diverting loop ileostomy (DLI).
Area of Science:
- Pediatric surgery
- Gastroenterology
- Inflammatory Bowel Disease research
Background:
- Severe refractory Crohn's colitis (CC) in pediatric patients often necessitates surgical intervention, such as total colectomy (TC) or diverting loop ileostomy (DLI).
- Limited understanding exists regarding the postoperative outcomes, including complications, nutritional status, and intestinal continuity restoration, following these procedures in pediatric CC patients.
Purpose of the Study:
- To evaluate and compare the postoperative outcomes of total colectomy (TC) versus diverting loop ileostomy (DLI) in pediatric patients with severe refractory Crohn's colitis (CC).
- To assess changes in nutritional status, growth parameters, and the feasibility of restoring intestinal continuity after TC and DLI.
Main Methods:
- A case series study identified pediatric patients with severe CC who underwent either TC or DLI.
- Data collected included demographics, pre- and postoperative anthropometric and biochemical measurements, surgical complications, and medication requirements.
- Level IV evidence was established through this case series methodology.
Main Results:
- Twenty-seven pediatric patients (22 TC, 5 DLI) were analyzed with a median follow-up of 45 months.
- TC patients demonstrated significant improvements in weight (z-score -1.08 to -0.54, p=0.02) and BMI (z-score -0.83 to -0.38, p=0.04) by one year post-surgery.
- Improvements in hemoglobin and albumin levels were noted in TC patients (p=0.003 and p=0.004, respectively), while DLI showed no significant nutritional improvement. Restoration of intestinal continuity was achieved in 45% of TC patients.
Conclusions:
- Total colectomy (TC) in pediatric patients with severe Crohn's colitis (CC) provides a viable option for enhancing nutritional status and promoting growth.
- The study suggests a reasonable likelihood of successfully restoring intestinal continuity following TC in this patient population.
- Diverting loop ileostomy (DLI) did not yield significant improvements in nutritional parameters and had limited success in restoring intestinal continuity.
Background:
Pediatric patients with severe refractory Crohn's colitis (CC) may require total colectomy (TC) or diverting loop ileostomy (DLI). Our understanding of outcomes (postoperative complications, nutrition and restoration of intestinal continuity) is currently limited.
Methods:
Pediatric patients with severe CC who underwent TC or DLI were identified. Demographics, pre and postoperative anthropometric and biochemical data, surgical complications and medication requirements were recorded.
Results:
Twenty-seven patients (TC=22, DLI=5) with a median age of 15.0years (range 3-18) were identified, 64% male with a median follow-up of 45months (range 3-120). Mean weight and BMI improved for TC patients by 1year postoperatively - weight z-score from -1.08 to -0.54 (p=0.02), BMI z-score from -0.83 to -0.38 (p=0.04), with a non-significant height change from - 0.79 to -0.65 (p=0.07). Mean hemoglobin and albumin both also improved - 9.88g/dl to 11.76g/dl (p=0.003) and 3.44g/dl to 4.03g/dl (p=0.004) respectively. These measures did not significantly improve after DLI. Most TC patients (59%) had attempted restoration of intestinal continuity with 45% in continuity at end of follow-up. One DLI patient underwent ileostomy takedown but subsequently needed re-diversion.
Conclusions:
In severe CC, TC offers an opportunity to improve nutrition and growth, with a reasonable likelihood of restoring intestinal continuity.
Level Of Evidence:
Level IV - Case series.
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