Total intracorporeal laparoscopic resection of Crohn's disease,☆☆,

Presented at the 34th Annual Meeting of the Canadian Association of Paediatric Surgeons, Vancouver, British Columbia, Canada, September 19-22, 2002.
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Abstract

Background/Purpose: The benefits of laparoscopic resection for Crohn's disease have been well established in the adult literature. This modality more recently has been applied to children. The authors report their experience in this age group. Methods: A prospective series of all pediatric Crohn's patients treated laparoscopically in one surgical practice was studied for demographic data, operative details, and outcome. Results: Fifteen patients with diagnosis of Crohn's disease, ages 9 to 17 years, underwent laparoscopic ileocolic resection between February of 1998 and 2002. Patients' weights ranged from 42 to 80 kg. All patients had fixed strictures involving the terminal ileum and ileocecal valve and had failed medical therapy. A 4-port approach (one 12-mm and 3 5-mm) was utilized in all cases. Resection and anastomosis was performed intracorporeally, and the specimen was retrieved through the 12-mm port site. The average operating time was 110 minutes (range, 90 to 180 minutes). Oral feedings were started after 24 hours of nasogastric suction. Hospital stay averaged 4 days (range, 3 to 8 days). One patient had a fever on postoperative day 3. Contrast study showed a small anastomotic leak with no associated collection, and the patient responded to conservative management. One other patient whose pathologic diagnosis questioned the initial Crohn's diagnosis presented with an anastomotic stricture and underwent redo resection laparoscopically with good outcome. No other complications were noted, and all patients were symptom free at follow-up. Conclusions: Laparoscopic resection of Crohn's disease in children is safe and effective. J Pediatr Surg 38:717-719. © 2003 Elsevier Inc. All rights reserved.

Section snippets

Materials and methods

A database was constructed prospectively for all patients undergoing laparoscopic resection of their ileocolic Crohn's disease over a 4-year period (February 1998 to February 2002) in one pediatric surgical practice. Data collected included demographics, indication for surgery, operative details, postoperative course, and outcome. Descriptive statistics were used for data analysis

A total of 15 patients, ages 9 to 17 years (mean age, 14 years), underwent laparoscopic resection of their ileocolic

Discussion

Our data reflect findings from previous studies1, 2, 3, 4 that laparoscopic resection of ileocolic Crohn's disease can be performed safely on children with good outcome and acceptable operating time and morbidity. Experience from one of our patients suggests that laparoscopic reoperation also can be safely performed.

Intracorporeal resection and anastomosis offers the advantage of smaller incisions, less pain, and quicker recovery but requires an extra 5-mm port for construction of the

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☆☆

0022-3468/03/3805-0015$30.00/0

10.1016/S0022-3468(03)00035-6

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