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Crohn's disease in children and adolescents: is inadequate weight gain a valid indication for surgery?
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Surgical resection of diseased bowel in pediatric Crohn's disease patients significantly improves weight gain. This intervention is associated with low operative mortality and manageable complications, offering a positive outlook for growth.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease frequently affects children and adolescents, impacting growth and requiring medical or surgical management.
- Historically, surgical interventions for pediatric Crohn's disease have been evaluated for efficacy and safety.
Purpose of the Study:
- To review the outcomes of surgical management in hospitalized children and adolescents with Crohn's disease.
- To assess the impact of bowel resection on weight gain and overall patient response.
Main Methods:
- Retrospective review of 70 pediatric patients hospitalized for Crohn's disease between 1966 and 1976.
- Analysis of 60 operative procedures, including bowel resections, appendectomies, and abscess drainages.
- Evaluation of preoperative weight percentiles and postoperative weight changes in patients undergoing bowel resection.
Main Results:
- Operative mortality was 1.7% with 10 successfully managed complications.
- Among 26 children undergoing bowel resection, 22 were below the third percentile for weight preoperatively.
- Nearly two-thirds of these patients experienced substantial weight gain post-resection.
Conclusions:
- Surgical resection aimed at complete removal of diseased bowel is an effective strategy for promoting significant weight gain in pediatric Crohn's disease patients.
- The surgical approach demonstrated a favorable safety profile with low mortality and manageable complications.
- Surgical intervention can lead to positive growth responses in pediatric patients with Crohn's disease.
Abstract:
Seventy children and adolescents hospitalized for Crohn's disease at the University of Michigan Medical Center between 1966 and 1976 are reviewed. Thirty-three of these children were managed medically and 37 underwent a total of 60 operative procedures. There were 33 bowel resections, 7 appendectomies, 4 abscess drainages, 3 bowel bypasses, and 13 miscellaneous operative procedures. The total operative mortality was 1.7%, and there were 10 complications, all of which were successfully managed. Among the 26 children undergoing bowel resections, 22 were below the third percentile for weight preoperatively. Nearly two-thirds of these gained weight to the 35th percentile following resection. The remainder of the children had a variety of growth and symptomatic responses to surgery. Resection aimed at complete removal of diseased bowel can be expected to yield substantial weight gain in children with Crohn's disease.