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Published on: February 27, 2014
Colectomies in children with inflammatory bowel disease: a national referral centre experience
Ancuta Muntean1,2, Ionica Stoica3,4, Suzanne Victoria McMahon3
1Department of Paediatric Surgery, Our Lady's Children Hospital, Crumlin, Dublin, Ireland. ancutza_muntean@yahoo.com.
Insights
Laparoscopic colectomy in children with inflammatory bowel disease (IBD) is safe and effective, showing fewer complications than open surgery. This approach offers better recovery, particularly for elective procedures.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Minimally invasive surgery
Background:
- Laparoscopic colectomy's utility in pediatric inflammatory bowel disease (IBD) is under-reported.
- Comparison of open versus laparoscopic colectomy outcomes in pediatric IBD patients is needed.
Purpose of the Study:
- To compare the characteristics and outcomes of pediatric IBD patients undergoing open versus laparoscopic colectomy.
- To evaluate the safety and efficacy of laparoscopic colectomy in this population.
Main Methods:
- Retrospective review of 58 pediatric patients undergoing subtotal colectomy for IBD over 10 years.
- Data collected included demographics, surgical approach (open vs. laparoscopic), operative details, histopathology, post-operative course, and complications.
- Comparison of complication rates between open and laparoscopic procedures, and between elective and emergency surgeries.
Main Results:
- 38 of 58 patients (65.5%) underwent laparoscopic colectomy.
- Laparoscopic colectomy had a significantly lower complication rate (42.1%) compared to open colectomy (75%).
- Elective colectomies also showed lower complication rates (38.4%) versus emergency procedures (75%). Four patients (10.5%) required conversion to open surgery.
Conclusions:
- Laparoscopic colectomy is a feasible and safe surgical option for pediatric patients with IBD.
- The laparoscopic approach is associated with lower complication rates and improved recovery compared to open surgery.
- Elective laparoscopic colectomy offers particular benefits in terms of reduced complications and enhanced recovery for pediatric IBD patients.
Objectives:
Few studies have reported on the utility and efficacy of laparoscopic colectomy in the paediatric population. We aim to compare the characteristics and outcomes of children with inflammatory bowel disease (IBD) who underwent open vs laparoscopic treatment at our centre.
Methods:
A 10-year retrospective review was performed. Collected data included demographics, indication for surgery, operative characteristics, histopathology results, post-operative course and peri-operative complications.
Results:
A total of 58 patients underwent subtotal colectomy for IBD, with 38 laparoscopic procedures. The cohort included 33 males and 25 females with a mean age at surgery of 12.9 ± 3.3 years. The pre-operative diagnosis was ulcerative colitis in n = 41, Crohn's disease in n = 5 and indeterminate colitis in n = 11. There was an 84.2% concordance between the pre-operative and the post-operative histological diagnoses. Overall, 34 (58.6%) patients had complications, of which 19 (32.7%) patients required return to theatre. The complication rate was significantly smaller for laparoscopic compared to open procedures (42.1% vs 75%) as well as for elective compared with emergency colectomies (38.4% vs 75%). Four patients (10.5%) required conversion to open approach.
Conclusions:
Laparoscopic approach is feasible and safe in most paediatric patients with IBD and has a lower complication rate and better recovery than open procedures, especially when performed in an elective setting.
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