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Outcome after surgical intervention in children with chronic inflammatory bowel disease
1Division of Pediatric Gastroenterology, Children's Hospital of Michigan, Wayne State University, Detroit, USA.
Insights
Surgery can improve quality of life for pediatric patients with chronic inflammatory bowel disease (CIBD). Best outcomes were observed in cases of localized disease, with significant symptom relief and improved growth noted post-operation.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Chronic inflammatory bowel disease (CIBD) significantly impacts children and adolescents.
- Surgical intervention is sometimes necessary for managing severe pediatric CIBD cases.
- Understanding surgical outcomes in this population is crucial for treatment planning.
Purpose of the Study:
- To evaluate the outcomes of surgical interventions in pediatric patients with chronic inflammatory bowel disease (CIBD).
- To identify factors associated with successful surgical management and long-term results in children and adolescents with CIBD.
Main Methods:
- Retrospective review of 32 pediatric patients (4-17 years) with CIBD who underwent surgery between 1979 and 1992.
- Analysis of indications for surgery, disease extent (ulcerative colitis, Crohn's disease), and post-operative outcomes.
- Assessment of symptom relief, recurrence, need for further treatment, and growth response.
Main Results:
- 47% of patients experienced complete symptom relief for at least 1 year post-surgery.
- 22% had symptom recurrence managed with medical treatment; 2 required re-operation.
- Surgery for growth retardation led to catch-up growth in all affected patients.
- Localized disease correlated with the best surgical outcomes.
Conclusions:
- Surgical treatment can effectively decrease morbidity and enhance the quality of life for pediatric CIBD patients.
- Optimal results from surgery are most frequently achieved in cases involving localized disease.
- Surgery offers a viable option for managing specific complications and improving growth in children with CIBD.
Abstract:
A retrospective review of 32 children and adolescents (18 males and 14 females) with chronic inflammatory bowel disease (CIBD) requiring surgery was undertaken. These patients were followed between 1979 and 1992. Their age range was from 4 to 17 years at the time of diagnosis (mean age, 11 years). The interval between the time of diagnosis and surgery ranged from 2 months to 11 years (mean, 3.7 years). Ten patients had ulcerative colitis and 22 had Crohn's disease. These patients represented 12 per cent of patients with CIBD seen at the Gastroenterology Clinic of Children's Hospital of Michigan during these 13 years. Indications for surgery included failure of medical treatment (seven patients), localized disease with significant side effects of therapy (nine), partial or complete obstruction (five), growth retardation (six), perforation (two), abscess and fistula (three). The extent of disease was as follows: panenteric, 2 patients; enteric, 2 patients; ileocecal, 15 patients; and colonic, 13 patients. In 15 patients (47%) surgery led to complete relief of symptoms for a minimum of 1 year after surgery. Seven patients (22%) had recurrence of symptoms that were controlled by medical treatment. Two patients required a second surgery and additional medical and nutritional treatment. All six patients having surgery for growth retardation showed catch-up growth in weight and height. We conclude that surgery can decrease morbidity and improve quality of life in CIBD patients. Best results are obtained in patients with localized disease.