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A retrospective comparison of outcomes for open vs. laparoscopic surgical techniques in pediatric ulcerative colitis
Brent A Willobee1, Jennifer A Nguyen1, Anthony Ferrantella1
1Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Insights
Laparoscopic surgery shows fewer complications than open surgery for pediatric ulcerative colitis (UC). This approach may be preferable for young patients needing colectomy or proctocolectomy.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Ulcerative colitis (UC) presents aggressively in pediatric patients, leading to significant lifelong morbidity.
- Surgical intervention is sometimes necessary for managing pediatric UC.
- Comparing surgical approaches is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare surgical complications between laparoscopic and open surgical treatments for ulcerative colitis (UC) in pediatric patients.
- To evaluate the safety and efficacy of different surgical techniques in young UC patients.
Main Methods:
- Utilized the Kids' Inpatient Database (KID) for UC surgical cases in 2009 and 2012.
- Analyzed data for patients undergoing total colectomy without proctectomy (n=413) and total proctocolectomy (n=196).
- Performed univariate and multivariate analyses comparing laparoscopic versus open procedures.
Main Results:
- Open procedures for total colectomy without proctectomy showed higher complication rates (e.g., fluid/electrolyte disorders, wound dehiscence, septicemia).
- Total proctocolectomy via open surgery had increased transfusion needs and more gastrointestinal upset compared to laparoscopic.
- Multivariate analysis indicated an increased risk of complications with open or non-elective surgery (OR >2.4, P<0.001).
Conclusions:
- The laparoscopic approach is linked to substantially lower surgical complication rates in pediatric UC patients.
- Laparoscopic technique demonstrates favorable outcomes and may be the preferred method for selected pediatric UC patients.
- Minimally invasive surgery offers a safer alternative for UC treatment in children.
Background:
Ulcerative colitis (UC) is an aggressive disease in the pediatric population and a cause of significant, lifelong morbidity. The aim of this study is to compare surgical complications in pediatric patients undergoing laparoscopic vs. open surgical treatment for UC.
Methods:
We queried the Kids' Inpatient Database (KID) for all cases of UC undergoing surgical treatment in 2009 and 2012. We identified patients who received total colectomy without proctectomy (n=413) or total proctocolectomy (n=196) and performed univariate and multivariate analyses comparing laparoscopic vs. open procedures.
Results:
In pediatric UC patients undergoing total colectomy without proctectomy, open procedures were associated with more complications than laparoscopic, including fluid and electrolyte disorders (40% vs. 28%), surgical wound dehiscence (6% vs. 2%), septicemia (18% vs. 2%), and gastrointestinal disorders (16% vs. 7%) among others, all P<0.05. Likewise, in patients with UC undergoing total proctocolectomy, there were more complications in open vs. laparoscopic technique, including increased transfusion requirements (25% vs. 7%, P=0.001) and significantly more gastrointestinal upset, including nausea, vomiting, and diarrhea (11% vs. 1%, P=0.003). In multivariate analysis, patients who underwent total colectomy with or without proctectomy had an increased risk of experiencing any complication when their procedure was performed in an open or non-elective fashion (all odds ratio >2.4; all P<0.001).
Conclusions:
The laparoscopic approach was associated with significantly lower rates of surgical complications in pediatric patients undergoing total colectomy with or without proctectomy for UC. These findings demonstrate that laparoscopic technique compares favorably, and may be preferable, to the open approach in selected pediatric patients with UC.
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