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Outcomes after laparoscopic surgery in children with inflammatory bowel disease

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Abstract

Background

The utility and efficacy of the laparoscopic approach to the management of inflammatory bowel disease (IBD) in children are not clearly known.

Methods

We conducted a retrospective descriptive cohort study of children with a diagnosis of IBD who underwent a laparoscopic or laparoscopy-assisted procedure at a quaternary pediatric referral center between 1999 and 2007.

Results

One-hundred thirty-six children underwent 154 operations (85 small bowel/ileocolic and 69 colorectal) over the 8 years of the study. Median age was 14.8 years (range = 1.8–18.8). The diagnosis was Crohn’s disease in 83, ulcerative colitis in 50, and indeterminate colitis in 3. Median time to regular diet was 5 days (range = 1–19), and median postoperative stay was 7 days (range = 1–70). Seven patients undergoing a small bowel/ileocolic resection (8.2%) were converted to an open procedure. Overall morbidity for the small bowel/ileocolic procedures was 27.1%. The conversion rate during subtotal colectomy (STC) was 7.1% (3/42), and it was 0% for the 22 patients who underwent ileal pouch-anal anastomosis (IPAA) procedures. Overall morbidity associated with STC was 62.8%, and following IPAA it was 63.6%. Sixteen percent (7/69) of those who underwent a colorectal procedure developed a late postoperative bowel obstruction with three patients requiring operative intervention.

Conclusion

A laparoscopic approach is feasible with a low conversion rate in most children with IBD. Despite superior cosmesis, perioperative morbidity is similar to that seen with open procedures. Laparoscopic colorectal IBD procedures are associated with an unexpectedly high incidence of postoperative bowel obstruction, although the rates are comparable to those seen with open surgery.

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Acknowledgments

The authors thank Linda Whyte and Robin Vaughan for their assistance with this project. Ivan Diamond was supported by a Johnson & Johnson Medical Products Surgeon Scientist Program Fellowship with additional support from the Surgeon Scientist Training Program, Department of Surgery, University of Toronto. Dr. Diamond is also the recipient of a Fellowship award from the Canadian Institutes of Health Research.

Disclosures

I. R. Diamond has received grant funding from Fresenius Kabi for a study that is unrelated to the management of patients with inflammatory bowel disease. J. T. Gerstle, P. C. W. Kim, and J. C. Langer have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada

    Ivan R. Diamond, J. Ted Gerstle, Peter C. W. Kim & Jacob C. Langer

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  1. Ivan R. Diamond
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  2. J. Ted Gerstle
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  3. Peter C. W. Kim
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  4. Jacob C. Langer
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Correspondence to Jacob C. Langer.

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Diamond, I.R., Gerstle, J.T., Kim, P.C.W. et al. Outcomes after laparoscopic surgery in children with inflammatory bowel disease. Surg Endosc 24, 2796–2802 (2010). https://doi.org/10.1007/s00464-010-1050-x

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  • DOI: https://doi.org/10.1007/s00464-010-1050-x

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