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Published in: Pediatric Surgery International 6/2019

01-06-2019 | Ulcerative Colitis | Original Article

Colectomies in children with inflammatory bowel disease: a national referral centre experience

Published in: Pediatric Surgery International | Issue 6/2019

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Abstract

Objectives

Few studies have reported on the utility and efficacy of laparoscopic colectomy in the paediatric population. We aim to compare the characteristics and outcomes of children with inflammatory bowel disease (IBD) who underwent open vs laparoscopic treatment at our centre.

Methods

A 10-year retrospective review was performed. Collected data included demographics, indication for surgery, operative characteristics, histopathology results, post-operative course and peri-operative complications.

Results

A total of 58 patients underwent subtotal colectomy for IBD, with 38 laparoscopic procedures. The cohort included 33 males and 25 females with a mean age at surgery of 12.9 ± 3.3 years. The pre-operative diagnosis was ulcerative colitis in n = 41, Crohn’s disease in n = 5 and indeterminate colitis in n = 11. There was an 84.2% concordance between the pre-operative and the post-operative histological diagnoses. Overall, 34 (58.6%) patients had complications, of which 19 (32.7%) patients required return to theatre. The complication rate was significantly smaller for laparoscopic compared to open procedures (42.1% vs 75%) as well as for elective compared with emergency colectomies (38.4% vs 75%). Four patients (10.5%) required conversion to open approach.

Conclusions

Laparoscopic approach is feasible and safe in most paediatric patients with IBD and has a lower complication rate and better recovery than open procedures, especially when performed in an elective setting.
Literature
1.
go back to reference Levine A, Koletzko S, Turner D et al (2014) ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 58:795–806 Levine A, Koletzko S, Turner D et al (2014) ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 58:795–806
2.
go back to reference Ruel J, Ruane D, Mehandru S et al (2014) IBD across the age spectrum: is it the same disease? Nat Rev Gastroenterol Hepatol 11:88–98CrossRefPubMed Ruel J, Ruane D, Mehandru S et al (2014) IBD across the age spectrum: is it the same disease? Nat Rev Gastroenterol Hepatol 11:88–98CrossRefPubMed
3.
go back to reference Sawczenko A, Sandhu BK, Logan RF et al (2001) Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet 357:1093–1094CrossRefPubMed Sawczenko A, Sandhu BK, Logan RF et al (2001) Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet 357:1093–1094CrossRefPubMed
4.
go back to reference Adamiak T, Walkiewicz-Jedrzejczak D, Fish D et al (2013) Incidence, clinical characteristics, and natural history of pediatric IBD in Wisconsin: a population-based epidemiological study. Inflamm Bowel Dis 19(6):1218–1223CrossRefPubMedPubMedCentral Adamiak T, Walkiewicz-Jedrzejczak D, Fish D et al (2013) Incidence, clinical characteristics, and natural history of pediatric IBD in Wisconsin: a population-based epidemiological study. Inflamm Bowel Dis 19(6):1218–1223CrossRefPubMedPubMedCentral
5.
go back to reference Benchimol EI, Bernstein CN, Bitton A et al (2017) Trends in epidemiology of pediatric inflammatory bowel disease in Canada: distributed network analysis of multiple population-based provincial health administrative databases. Am J Gastroenterol 112(7):1120CrossRefPubMedPubMedCentral Benchimol EI, Bernstein CN, Bitton A et al (2017) Trends in epidemiology of pediatric inflammatory bowel disease in Canada: distributed network analysis of multiple population-based provincial health administrative databases. Am J Gastroenterol 112(7):1120CrossRefPubMedPubMedCentral
6.
go back to reference Molodecky NA, Soon IS, Rabi DM et al (2012) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142:46–54 (quiz e30)CrossRef Molodecky NA, Soon IS, Rabi DM et al (2012) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142:46–54 (quiz e30)CrossRef
7.
go back to reference Hancock L, Windsor AC, Mortensen NJ (2006) Inflammatory bowel disease: the view of the surgeon. Colorectal Dis 8:10–14CrossRefPubMed Hancock L, Windsor AC, Mortensen NJ (2006) Inflammatory bowel disease: the view of the surgeon. Colorectal Dis 8:10–14CrossRefPubMed
8.
go back to reference Page AE, Sashittal SG, Chatzizacharias NA et al (2015) The role of laparoscopic surgery in the management of children and adolescents with inflammatory bowel disease. Medicine 94:e874CrossRefPubMedPubMedCentral Page AE, Sashittal SG, Chatzizacharias NA et al (2015) The role of laparoscopic surgery in the management of children and adolescents with inflammatory bowel disease. Medicine 94:e874CrossRefPubMedPubMedCentral
9.
go back to reference WHO Multicentre Growth Reference Study Group (2006) WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. World Health Organization, Geneva, pp 13–77, 229–300 WHO Multicentre Growth Reference Study Group (2006) WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. World Health Organization, Geneva, pp 13–77, 229–300
11.
12.
go back to reference Georgeson KE (2002) Laparoscopic-assisted total colectomy with pouch reconstruction. Semin Pediatr Surg 11:233–236CrossRefPubMed Georgeson KE (2002) Laparoscopic-assisted total colectomy with pouch reconstruction. Semin Pediatr Surg 11:233–236CrossRefPubMed
13.
go back to reference Proctor ML, Langer JC, Gerstle JT et al (2002) Is laparoscopic subtotal colectomy better than open subtotal colectomy in children? J Pediatr Surg 37:706–708CrossRefPubMed Proctor ML, Langer JC, Gerstle JT et al (2002) Is laparoscopic subtotal colectomy better than open subtotal colectomy in children? J Pediatr Surg 37:706–708CrossRefPubMed
14.
go back to reference Coughlan A, Wylde R, Lafferty L, Quinn S, Broderick A, Bourke B, Hussey S, DOCHAS Study (2017) A rising incidence and poorer male outcomes characterise early onset paediatric inflammatory bowel disease. Aliment Pharmacol Ther 45(12):1534–1541CrossRefPubMed Coughlan A, Wylde R, Lafferty L, Quinn S, Broderick A, Bourke B, Hussey S, DOCHAS Study (2017) A rising incidence and poorer male outcomes characterise early onset paediatric inflammatory bowel disease. Aliment Pharmacol Ther 45(12):1534–1541CrossRefPubMed
15.
go back to reference Hope B, Shahdadpuri R, Dunne C, Broderick AM, Grant T, Hamzawi M, O’Driscoll K, Quinn S, Hussey S, Bourke B (2012) Rapid rise in incidence of Irish paediatric inflammatory bowel disease. Arch Dis Child 97(7):590–594CrossRefPubMed Hope B, Shahdadpuri R, Dunne C, Broderick AM, Grant T, Hamzawi M, O’Driscoll K, Quinn S, Hussey S, Bourke B (2012) Rapid rise in incidence of Irish paediatric inflammatory bowel disease. Arch Dis Child 97(7):590–594CrossRefPubMed
16.
go back to reference Kelley-Quon LI, Tseng CH, Jen HC et al (2012) Postoperative complications and health care use in children undergoing surgery for ulcerative colitis. J Pediatr Surg 47(11):2063–2070CrossRefPubMed Kelley-Quon LI, Tseng CH, Jen HC et al (2012) Postoperative complications and health care use in children undergoing surgery for ulcerative colitis. J Pediatr Surg 47(11):2063–2070CrossRefPubMed
17.
go back to reference Diamond IR, Gerstle JT, Kim PC et al (2010) Outcomes after laparoscopic surgery in children with inflammatory bowel disease. Surg Endosc 24:2796–2802CrossRefPubMed Diamond IR, Gerstle JT, Kim PC et al (2010) Outcomes after laparoscopic surgery in children with inflammatory bowel disease. Surg Endosc 24:2796–2802CrossRefPubMed
18.
go back to reference Flores P, Bailez MM, Cuenca E et al (2010) Comparative analysis between laparoscopic (UCL) and open (UCO) technique for the treatment of ulcerative colitis in pediatric patients. Pediatr Surg Int 26(9):907–911CrossRefPubMed Flores P, Bailez MM, Cuenca E et al (2010) Comparative analysis between laparoscopic (UCL) and open (UCO) technique for the treatment of ulcerative colitis in pediatric patients. Pediatr Surg Int 26(9):907–911CrossRefPubMed
19.
go back to reference Pini-Prato A, Faticato MG, Barabino A et al (2015) Minimally invasive surgery for paediatric inflammatory bowel disease: personal experience and literature review. World J Gastroenterol 21(40):11312CrossRefPubMedPubMedCentral Pini-Prato A, Faticato MG, Barabino A et al (2015) Minimally invasive surgery for paediatric inflammatory bowel disease: personal experience and literature review. World J Gastroenterol 21(40):11312CrossRefPubMedPubMedCentral
20.
go back to reference Soon S, Wrobel I, Jennifer CC et al (2012) Postoperative complications following colectomy for ulcerative colitis in children. J Pediatr Gastroenterol Nutr 54(6):763–768CrossRefPubMed Soon S, Wrobel I, Jennifer CC et al (2012) Postoperative complications following colectomy for ulcerative colitis in children. J Pediatr Gastroenterol Nutr 54(6):763–768CrossRefPubMed
21.
go back to reference Mattioli G, Pini-Prato A, Barabino A et al (2011) Laparoscopic approach for children with inflammatory bowel diseases. Pediatr Surg Int 27(8):839–846CrossRefPubMed Mattioli G, Pini-Prato A, Barabino A et al (2011) Laparoscopic approach for children with inflammatory bowel diseases. Pediatr Surg Int 27(8):839–846CrossRefPubMed
23.
go back to reference Griffiths AM, Hugot J-P (2004) Crohn disease. In: Walker A, Goulet O, Kleinman RE et al (eds) Pediatric gastrointestinal disease, 4th edn. BC Decker, Ottawa Griffiths AM, Hugot J-P (2004) Crohn disease. In: Walker A, Goulet O, Kleinman RE et al (eds) Pediatric gastrointestinal disease, 4th edn. BC Decker, Ottawa
Metadata
Title
Colectomies in children with inflammatory bowel disease: a national referral centre experience
Publication date
01-06-2019

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