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Surgical treatment of Crohn's disease
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Surgical intervention for pediatric Crohn's disease (CD) is increasingly necessary. While recurrence rates remain high, surgery significantly improves quality of life and offers a 50% chance of long-term remission.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease affecting children.
- The incidence, severity, and age of onset of pediatric CD appear to be increasing.
- Surgical management is often required for complicated cases in pediatric patients.
Purpose of the Study:
- To evaluate surgical outcomes in children with Crohn's disease.
- To identify indications for surgery and assess its impact on quality of life.
- To analyze the long-term disease-free status after surgical intervention.
Main Methods:
- Retrospective review of 93 pediatric Crohn's disease patients treated between 1967 and 1979.
- Analysis of 39 patients who underwent surgical procedures, including drainage and bowel resection.
- Review of preoperative preparation, surgical indications, and postoperative outcomes.
Main Results:
- 39 of 93 children underwent surgery, with indications including obstruction, fistula, abscess, hemorrhage, growth failure, and toxic megacolon.
- No deaths occurred, and postoperative infections were minimal (2 patients).
- Despite high recurrence rates, surgery led to improved quality of life, growth, and a 50% chance of being disease-free at 10 years.
Conclusions:
- Surgical intervention is a viable option for pediatric Crohn's disease, offering significant benefits in quality of life and growth.
- Preoperative nutritional preparation (enteral and parenteral) for 3-6 weeks enhances surgical safety.
- While recurrence is common, surgical management provides a substantial chance for long-term remission and improved patient well-being.
Abstract:
Of 93 children with Crohn's disease treated at the Hôpital Sainte-Justine between 1967 and 1979, 39 were operated on. Ten had abscesses and anal fistulas drained and in 29 the bowel was resected. The mean age of the children was 13 years. The average time between onset and diagnosis for both the medical and surgical groups was 13 months. Medical treatment failed in 25 patients after an average time of 22 +/- 17 months. Fourteen patients had an initial laparotomy, with a false diagnosis of appendicitis in 8, abdominal tumour in 2 and Meckel's diverticulum in 1. Indications for operation were: intestinal obstruction, bowel fistula, intra-abdominal abscess, gastrointestinal hemorrhage, growth failure and toxic megacolon. There were no deaths and only two postoperative infections. Crohn's disease seems to be becoming more frequent, more severe and starting earlier in life. Three to 6 weeks of preoperative preparation with enteral and parenteral nutrition allows operation to be performed under safer conditions. Although the recurrence rate after operation is still high, there is no doubt that the children enjoy a better quality of life, growth and a 50% chance of being disease-free 10 years later.