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Pediatric Colorectal Surgery: A Collaborative Approach From a Single Institution
Courtney Pisano1, Ipek Sapci2, Paul A Karam3
1Department of Pediatric Surgery, Nationwide Children's Hospital 700 Children's Drive, Columbus, Ohio.
Insights
Collaborative colorectal surgery involving pediatric and adult specialists improved outcomes for pediatric inflammatory bowel disease patients, reducing recovery time and hospital stays. This approach shows short-term benefits without increasing complication rates.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Gastroenterology
Background:
- Inflammatory bowel disease (IBD) frequently affects pediatric patients, often requiring lifelong management and surgical intervention.
- A significant portion of IBD diagnoses occur in individuals under 20, necessitating specialized, long-term care.
- Collaboration between pediatric and adult colorectal surgeons may enhance patient outcomes and experiences.
Purpose of the Study:
- To investigate the impact of collaborative surgical approaches on short-term outcomes in pediatric patients with inflammatory bowel disease.
- To compare outcomes between cases managed by pediatric surgeons alone, adult colorectal surgeons alone, and a collaborative team.
Main Methods:
- Retrospective analysis of 116 pediatric patients (≤18 years) undergoing colorectal resections for IBD between 2010-2017.
- Data collected included patient demographics, surgical procedures, surgeon involvement (pediatric, colorectal, collaborative), operative details, and postoperative recovery metrics.
- Outcomes analyzed included time to flatus and bowel movement, length of hospital stay, and surgical complication rates.
Main Results:
- The collaborative surgical group demonstrated significantly shorter times to flatus (2.27 days) and first bowel movement (2.64 days).
- Patients in the collaborative group also experienced a shorter length of hospital stay (4.45 days).
- Single-incision laparoscopic surgery was more prevalent in the collaborative group (77.8%), with no significant difference in complication rates across all groups.
Conclusions:
- Collaborative surgical management by pediatric and colorectal surgeons is associated with improved short-term outcomes for pediatric IBD patients.
- This multidisciplinary approach led to faster recovery and shorter hospitalizations.
- The findings support the integration of pediatric and adult surgical expertise for optimal care in pediatric colorectal surgery for IBD.
Background:
Inflammatory bowel disease encompasses relapsing gastrointestinal disorders commonly presenting in pediatric patients, with 25% of diagnoses made before age 20 and 4% before age 5. Considering the need for life-long surgical follow-up, a collaborative system involving both pediatric and colorectal surgeons could improve overall patient experiences. We hypothesized that cases performed in collaboration with both pediatric and adult colorectal surgeons may lead to better outcomes.
Methods:
Data were gathered retrospectively for 116 patients 18 y old or younger who underwent colorectal resections for inflammatory bowel disease between 2010 and 2017 at our institution. Data included patient demographics, type of procedure, surgical approach, specimen extraction site, surgeon involvement (pediatric, colorectal, or collaborative), operative time, and estimated blood loss. We analyzed days until passage of flatus and bowel movement, length of stay, type of surgical procedure, and surgical complications.
Results:
Our data showed that days until flatus (2.27 ± 0.47, P = 0.049), first bowel movement (2.64 ± 0.67, P = 0.006), and length of stay (4.45 ± 1.51, P = 0.006) were the shortest in the collaborative group. We also found that single-incision laparoscopic surgery was significantly more common in the collaborative group (77.8%, P = 0.002). We did not see a difference in surgical complication rates among any of the groups.
Conclusions:
Our study showed short-term beneficial outcomes in a single institution associated with the collaboration of pediatric surgeons and colorectal surgeons on pediatric colorectal cases in comparison to those performed by pediatric surgeons or adult colorectal surgeons alone.
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