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Open Versus Laparoscopic Right Hemicolectomies in Pediatric Patients with Crohn's Disease
Hallie J Quiroz1, Eduardo A Perez1, Rana A El Tawil1
1Division of Pediatric Surgery, DeWitt Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA.
Insights
Laparoscopic right hemicolectomy (LRH) shows similar safety to open right hemicolectomy (ORH) for pediatric Crohn's disease, with fewer complications and lower costs. LRH may be a superior surgical option for select patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Comparative Effectiveness Research
Background:
- Surgery is a key treatment for pediatric Crohn's disease (CD).
- Comparative data on open right hemicolectomy (ORH) versus laparoscopic right hemicolectomy (LRH) in pediatric CD is limited.
Purpose of the Study:
- To compare outcomes of ORH and LRH in pediatric CD patients.
- To identify potential advantages of laparoscopic over open procedures in this population.
Main Methods:
- Analysis of the Kids' Inpatient Database (KID) from 2009-2012.
- Propensity score-matched analysis (PSMA) of 380 ORH and 380 LRH cases in pediatric CD patients.
- Comparison of in-hospital mortality, morbidity, length of stay, and hospital charges.
Main Results:
- Both ORH and LRH demonstrated low in-hospital mortality.
- ORH was linked to higher rates of septicemia, respiratory compromise, pneumonia, perforation, and blood transfusions.
- LRH resulted in shorter hospital stays and lower overall costs, despite higher rates of postoperative nausea/vomiting/diarrhea.
Conclusions:
- Laparoscopic right hemicolectomy (LRH) is a safe and feasible alternative to open right hemicolectomy (ORH) for pediatric Crohn's disease.
- LRH is associated with reduced morbidity and resource utilization compared to ORH.
- LRH may offer superior outcomes for select pediatric CD patients requiring hemicolectomy.
Abstract:
Surgery remains an important treatment modality for the management of pediatric Crohn's disease (CD). The objective of this study was to perform a comparative analysis of open right hemicolectomy (ORH) and laparoscopic right hemicolectomy (LRH) for the management of pediatric CD. The Kids' Inpatient Database (KID) was queried (2009-2012) for ICD-9 procedure codes for ORH (45.73) and LRH (17.33) in patients with CD (ICD-9 codes: 555.0, 555.1, 555.2, 555.9). Open and laparoscopic procedures were compared using propensity score (PS)-matched analysis (PSMA) of 41 variables. Overall 889 patients were identified and after PS matching, there were 380 ORHs and 380 LRHs. There were zero in-hospital deaths (0/821). ORH patients were more likely to have septicemia, respiratory compromise, pneumonia, perforation and/or laceration, complications, and require blood transfusions (all, P < .05). Although LRH patients were more likely to develop postoperative nausea/vomiting/diarrhea (P < .0001), they had a shorter hospital length of stay (P < .0001) and lower overall hospital charges and cost (P < .001). ORH and LRH in KID have similar low in-hospital mortality in pediatric CD. However, ORH was associated with higher morbidity including an increased risk for respiratory complications, surgical complications, need for blood transfusions, and increased resource utilization than patients who had laparoscopic procedures. In select patients, LRH is safe, feasible, and potentially superior to ORH.
