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Surgical therapy of chronic inflammatory bowel disease in childhood
1St Bartholomew's Hospital, West Smithfield, London, UK.
Insights
Surgery offers significant benefits for children with Crohn's disease and idiopathic proctocolitis, improving growth and relieving symptoms with low complication rates. Timely surgical intervention and multidisciplinary care are key to successful outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease
Background:
- Crohn's disease and idiopathic proctocolitis significantly impact pediatric patients' quality of life.
- Surgical intervention is often necessary for managing severe cases in children.
- Concerns regarding high morbidity rates associated with pediatric IBD surgery exist.
Purpose of the Study:
- To evaluate the benefits and outcomes of surgical interventions in pediatric patients with Crohn's disease and idiopathic proctocolitis.
- To assess the complication rates associated with these surgical procedures.
- To highlight the importance of multidisciplinary care and optimal timing of surgery.
Main Methods:
- Review of surgical cases from Paediatric Gastroenterology and Surgery departments.
- Analysis of patient nutrition status pre- and post-operatively.
- Assessment of growth velocity, symptom relief, and complication rates.
- Emphasis on collaborative decision-making between physicians, surgeons, and patients/parents.
Main Results:
- Surgery confers substantial benefits, including improved growth velocity and symptom resolution.
- Surgical procedures demonstrated a remarkably low complication rate.
- Optimal nutritional status and correctly timed interventions are crucial for favorable outcomes.
- Multidisciplinary team approach and patient/parent involvement enhance management.
Conclusions:
- Surgical management of pediatric Crohn's disease and idiopathic proctocolitis is highly effective.
- Careful patient selection, nutritional optimization, and precise surgical timing minimize risks.
- Integrated care pathways and shared decision-making are vital for successful long-term management and improved patient outcomes.
Abstract:
The overall impression gained from the experience of the Departments of Paediatric Gastroenterology and Surgery attached to St Bartholomew's Hospital are the enormous benefits that surgery has to confer on the large percentage of children with both Crohn's disease and idiopathic proctocolitis who require it. The surgical procedures described in this chapter have been accompanied by a remarkably low complication rate, dispelling the impression that morbidity in such cases would be high. This must in large measure be due to the fact that the children who come to surgery are in as good a state of nutrition as can be achieved by means of the various forms of enteral and parenteral feeding now available. Anxiety about healing of anastomoses and the development of fistulas after surgery for example, has not been a feature of the surgical care of these patients. The principal benefit of surgery has been a clear demonstration of an improvement in growth velocity in both Crohn's disease and idiopathic proctocolitis patients provided always that surgery is correctly timed. It is the author's experience that maximum benefit is achieved if the bulk of the diseased bowel can be removed. Plainly relief of symptoms such as abdominal pain and diarrhoea has also been rewarding. In many instances second procedures such as restorative proctectomy in idiopathic proctocolitis can be timed to fit in with educational commitments. In Crohn's disease the likelihood of recurrence in adult life is high but these patients are in a fit state to cope with further therapy including surgery should the need arise. From the management point of view the close cooperation between physicians and surgeons at all stages has been crucial, firstly to achieve smooth preparation prior to surgery and satisfactory after care. But of even more importance in the assessment of Crohn's disease is the presence of all clinicians involved in the case in the operating theatre so that the surgical options are fully assessed. This united approach avoids any unnecessary anxiety when, as inevitably happens, recurrence of symptoms due to relapse occurs. The involvement of patients of whatever age, and parents in all the decision making processes from the time of diagnosis has been vital. Early discussion about stomas involving members of the Stomatherapy Department has been invaluable. One final important aspect of the management of these patients is the seamless hand-over of care to an adult combined medical and surgical clinic at an appropriate time, usually at the age of 17 years.(ABSTRACT TRUNCATED AT 400 WORDS)