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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
[URGENT SURGICAL OPERATIONS FOR CROHN'S DISEASE IN CHILDREN]
O Gorbatyuk1, D Soleiko2, H Kurylo3
11 Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine.
Insights
Surgical intervention for complicated Crohn's disease in children, particularly intestinal obstructions and perforations, often requires intestinal resection and stoma formation. A combined conservative and surgical approach improves outcomes for this progressive condition.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease
Background:
- Crohn's disease is a progressive inflammatory bowel disease that can lead to severe surgical complications in children.
- Surgical interventions are often necessary for managing acute complications such as intestinal obstructions and perforations.
Purpose of the Study:
- To improve treatment outcomes for pediatric patients with complicated Crohn's disease.
- To analyze surgical interventions and their results in children with Crohn's disease complications.
Main Methods:
- Retrospective analysis of 23 pediatric patients (ages 1.5-17) treated for complicated Crohn's disease between 2008-2020.
- Integrated diagnostics including clinical, laboratory, radiological, endoscopic, sonographic, and morphological examination.
- Surgical treatment strategies tailored to specific complications, with a focus on intestinal resections and stoma formation.
Main Results:
- The most common complications were intestinal obstructions (34.78%) and perforations (26.09%).
- Intestinal resection with stoma formation was the most frequent surgical intervention.
- Good outcomes were achieved in most patients, with no observed mortality. However, 23.81% required relaparotomy due to postoperative complications.
Conclusions:
- Surgical complications are a significant concern in Crohn's disease, sometimes presenting as the initial manifestation.
- Intestinal obstruction and perforation are the leading surgical complications in pediatric Crohn's disease.
- A combined approach of conservative and surgical management is crucial for optimizing treatment results.
Abstract:
Aim - the improvement of treatment results of patients with complicated Crohn's disease based on study and analysis of own results of surgical interventions. Since 2008 to 2020 years 23 patients at the age 1,5-17 years old with Crohn's disease in 3 pediatric surgical hospitals have been observed. The article presents the analysis of surgical treatment of these patients with complications of main pathology. Diagnostics is integrated and includes clinical and laboratorian examination of patients, X-ray, endoscopic, sonography methods of examination and morphological research method of clinical biopsy. Complications of Crohn's disease were presented by intestinal obstructions (34,78% of cases), intestinal perforations (26,09%), acute appendicitis with mesadenitis (13,04%), intraabdominal abscesses (8,7%), intestinal hemorragia from inflammatory wart (4,35%), perianal inflammatory complications with fistulas (13,04%). The article has covered all possible methods of surgical operations depending on the type of complication. The most frequent surgical interventions were resections of intestinal stenosis with formation of intestinal stomas. The majority of patients have achieved good results after surgical interventions. 5 (23,81%) patients have got a relaparotomias because of such postoperative complications as anastomotic failure (1), recurrence of intestinal perforation (2) and recurrence of intestinal obstruction (2). Mortality has not been observed. Conclusions. 1. Because of Crohn's disease is a progressive disease, the opportunity of emergence of acute surgical complications of this pathology preserves. Our data show that urgent surgical complications of Crohn's disease in 47,83% of patients were the first manifestation of the disease, which was diagnosed during treatment and verified morphologically in the postoperative period. 2. In most cases surgical complications were intestinal obstruction (34,78% cases) and intestinal perforations (26,09%), and the most frequent surgical interventions for Crohn's disease in children were resections of the affected areas of the intestine with formation of intestinal stomas. 3. The modern tactic of surgical treatment of complicated of Crohn's disease in children based on local intestinal resections with intestinal stomas. 4. It is very important to use a combined approach combining conservative and surgical treatment. Surgical treatment and drug treatment of Crohn's disease should be complementary treatments.
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