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Surgery for children with Crohn's disease: indications, complications and outcome
  1. S C Blackburn1,
  2. A E Wiskin2,
  3. C Barnes3,
  4. K Dick1,
  5. N A Afzal3,
  6. D M Griffiths1,
  7. R M Beattie3,
  8. M P Stanton1
  1. 1Department of Paediatric Surgery, Southampton University Hospital NHS Trust, Southampton, UK
  2. 2Department of Paediatric Gastroenterology, University of Southampton, Southampton University Hospital NHS Trust, Southampton, UK
  3. 3Department of Paediatric Gastroenterology, Southampton University Hospital NHS Trust, Southampton, UK
  1. Correspondence to Mr M Stanton, Department of Paediatric Surgery, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK; michael.stanton{at}uhs.nhs.uk

Abstract

Background Outcome data for surgery in paediatric Crohn's disease are limited. We report 10 years’ experience at a regional paediatric gastroenterology centre.

Methods Children undergoing surgery for Crohn's disease (January 2002–December 2012) were identified from an onsite patient register. Patients were followed until transition to adult services. Data were obtained from medical records and are expressed as median (range).

Results Sixty-nine children, aged 13.8 years (6.3–17.0) at diagnosis, were included. 42 were male (61%). Follow-up was 1.8 years (27 days–6 years). Surgery followed diagnosis by 9 months (0 days–7 years). 52 children (75%) received thiopurines and 5 (7%) anti-TNF (tumour necrosis factor) therapy preoperatively. 58 (84%) underwent intra-abdominal surgery (40 right hemicolectomy, 8 stoma formation, 2 subtotal colectomy, 2 small bowel resection, 6 other) and 10 (14%) underwent surgery for perianal disease. The commonest indications for intra-abdominal surgery were stricturing disease 35 (60%) and unresponsive luminal disease 13 (22%). There were 13 (22%) early, and 5 (8.6%) late, complications following intra-abdominal surgery. Nine children had disease relapse, five required further surgery. Height SD scores (SDS) did not increase between diagnosis; −0.5 (−3.4–2.1) and most recent follow up; −0.4 (−3.0–1.1). Body Mass Index (BMI) SDS increased from −1.0 (−6.3–1.5) to −0.3 (−3.3–2.0) (p<0.05).

Conclusions Surgery was associated with a 22% early complication rate and a 15% risk of relapse. 21% of patients required a second unplanned intra-abdominal procedure. Surgical intervention was associated with an increase in BMI SDS, but not in height SDS.

Keywords
  • surgery
  • ileocaecectomy
  • outcomes
  • paediatrics

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