Abstract
Background
Minimally invasive surgery is being increasingly applied to inflammatory bowel diseases (IBDs). Few pediatric series from selected research have been described to date. This study describes a unicentric experience of laparoscopic treatment of children with IBDs.
Materials and methods
All consecutive patients with IBDs between February 2006 and February 2010 who underwent laparoscopic treatment were included. We reviewed notes and recorded demographic data, indications, perioperative management, surgical details, length of surgery, complications, postoperative management, length of hospitalization and functional outcome.
Results
We performed 25 procedures on 16 patients (12 ulcerative colitis, 3 Crohn’s disease, and 1 indeterminate colitis). Median age was 12 years. A total of 50% patients underwent elective surgery; 11 underwent staged laparoscopic subtotal colectomy (LSTC) followed by J-pouch ileorectal anastomosis (JPIRA). Three patients underwent straight LSTC + JPIRA. All procedures included protective ileostomy. Length of surgery ranged between 120 and 380 min depending on the procedure (LSTC ± JPIRA). No conversion was required. Length of hospitalization ranged between 3 and 18 days. We observed six complications (24%) mainly represented by adhesions that were effectively treated laparoscopically. Ten patients were restored (ileostomy closure) and were assessed for continence that turned out to be good in 80%.
Conclusions
Laparoscopy proved to be feasible, safe and effective for the treatment of IBD in children. Although we observed a relatively low incidence of complications, stoma site adhesions still remain the major issue, which can be effectively dealt with laparoscopically. Functional outcome as well as cosmesis is satisfactory. As results are encouraging, at present we prefer laparoscopy for the surgical treatment of IBD in pediatric patients.
Similar content being viewed by others
References
Carvalho R, Hyams JS (2007) Diagnosis and management of inflammatory bowel disease in children. Semin Pediatr Surg 16(3):164–171
Moir CR (2007) Surgical management of Crohn’s colitis. Semin Pediatr Surg 16(3):178–184
Kugathasan S, Judd RH, Hoffmann RG, Heikenen J, Telega G, Khan F, Weisdorf-Schindele S, San Pablo W, Perrault J Jr, Park R, Yaffe M, Brown C, Rivera-Bennett MT, Halabi I, Martinez A, Blank E, Werlin SL, Rudolph CD, Binion DG, Wisconsin Pediatric Inflammatory Bowel Disease Alliance (2003) Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a state-wide population-based study. J Pediatr 143(4):525–531
Bernstein CN, Wajda A, Svenson LW, MacKenzie A, Koehoorn M, Jackson M, Fedorak R, Israel D, Blanchard JF (2006) The epidemiology of inflammatory bowel disease in Canada: a population-based study. Am J Gastroenterol 101(7):1559–1568
Stordal K, Jahnsen J, Bentsen BS, Moum B (2004) Pediatric inflammatory bowel disease in southeastern Norway: a five-year follow-up study. Digestion 70(4):226–230
Bousvaros A, Sylvester F, Kugathasan S, Szigethy E, Fiocchi C, Colletti R, Otley A, Amre D, Ferry G, Czinn SJ, Splawski JB, Oliva-Hemker M, Hyams JS, Faubion WA, Kirschner BS, Dubinsky MC, Challenges in Pediatric IBD Study Groups (2006) Challenges in pediatric inflammatory bowel disease. Inflamm Bowel Dis 12(9):885–913
Sawczenko A, Sandhu BK, Logan RF, Jenkins H, Taylor CJ, Mian S, Lynn R (2001) Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet 7 357(9262):1093–1094
Mamula P, Telega GW, Markowitz JE, Brown KA, Russo PA, Piccoli DA, Baldassano RN (2002) Inflammatory bowel disease in children 5 years of age and younger. Am J Gastroenterol 97(8):2005–2010
Meinzer U, Ideström M, Alberti C, Peuchmaur M, Belarbi N, Bellaïche M, Mougenot JF, Cézard JP, Finkel Y, Hugot JP (2005) Ileal involvement is age dependent in pediatric Crohn’s disease. Inflamm Bowel Dis 11(7):639–644
Patel HI, Leichtner AM, Colodny AH, Shamberger RC (1997) Surgery for Crohn’s disease in infants and children. J Pediatr Surg 32(7):1063–1067
Knight CD, Griffen FD (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88(5):710–714
Meier AH, Roth L, Cilley RE, Dillon PW (2007) Completely minimally invasive approach to restorative total proctocolectomy with j-pouch construction in children. Surg Laparosc Endosc Percutan Tech 17(5):418–421
Simon T, Orangio G, Ambroze W, Schertzer M, Armstrong D (2003) Laparoscopic-assisted bowel resection in pediatric/adolescent inflammatory bowel disease: laparoscopic bowel resection in children. Dis Colon Rectum 46(10):1325–1331
Georgeson KE (2002) Laparoscopic-assisted total colectomy with pouch reconstruction. Semin Pediatr Surg 11(4):233–236
Beattie RM, Walker-Smith JA, Murch SH (1995) Indications for investigation of chronic gastrointestinal symptoms. Arch Dis Child 73(4):354–355
Langhorst J, Elsenbruch S, Mueller T, Rueffer A, Spahn G, Michalsen A, Dobos GJ (2005) Comparison of 4 neutrophil-derived proteins in feces as indicators of disease activity in ulcerative colitis. Inflamm Bowel Dis 11(12):1085–1091
Zholudev A, Zurakowski D, Young W, Leichtner A, Bousvaros A (2004) Serologic testing with ANCA, ASCA, and anti-OmpC in children and young adults with Crohn’s disease and ulcerative colitis: diagnostic value and correlation with disease phenotype. Am J Gastroenterol 99(11):2235–2241
Rogler G (2009) Medical management of ulcerative colitis. Dig Dis 27(4):542–549
Truelove SC, Witts LT (1955) Cortisone in ulcerative colitis: final report on a therapeutic trial. BMJ 2:1041–1048
Powell-Tuck J, Day DW, Brucknell NA, Wadsworth J, Lennard-Jones JE (1982) Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis. Dig Dis Sci 27:533–537
Rachmilewitz D (1989) Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. BMJ 298:82–86
Mattioli G, Buffa P, Martinelli M, Ivani G, Jasonni V (1998) All mechanical low rectal anastomosis in children. J Pediatr Surg 33(3):503–506
Mattioli G, Castagnetti M, Gandullia P, Torrente F, Jasonni V, Barabino AV (2005) Stapled restorative proctocolectomy in children with refractory ulcerative colitis. J Pediatr Surg 40(11):1773–1779
Hanneman M, Sprangers M, De Mick E, Ernest van Heurn LW, De Langen ZJ, Looyaard N, Madern GC, Rieu PN, van der Zee DC, van Silfhout M, Aronson DC (2001) Quality of life in patients with anorectal malformation or Hirschsprung’s disease. Development of a disease-specific questionnaire. Dis Col Rectum 40(11):1650–1660
Holschneider AM, Jesch NK, Stragholz E, Pfrommer W (2002) Surgical methods for anorectal malformations from Rehbein to Peña—critical assessment of score systems and proposal for a new classification. Eur J Pediatr Surg 12(2):73–82
Diamond IR, Gerstle JT, Kim PCW, Langer JC (2010) Outcomes after laparoscopic surgery in children with inflammatory bowel disease. Surg Endosc Endosc 24:2796–2802
Parks AG, Nicholls RJ, Belliveau P (1980) Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 67(8):533–538
Utsunomiya J, Iwama T, Imajo M, Matsuo S, Sawai S, Yaegashi K, Hirayama R (1980) Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 23(7):459–466
Bubrick MP, Jacobs DM, Levy M (1985) Experience with the endorectal pull-through and S pouch for ulcerative colitis and familial polyposis in adults. Surgery 98(4):689–699
Nicholls RJ, Moskowitz RL, Shepherd NA (1985) Restorative proctocolectomy with ileal reservoir. Br J Surg 72(Suppl):S76–S79
Fonkalsrud EW (1985) Endorectal ileal pullthrough with isoperistaltic ileal reservoir for colitis and polyposis. Ann Surg 202(2):145–152
Nelson RL, Prasad ML, Pearl RK, Abcarian H (1991) Inverted U-pouch construction for restoration of function in patients with failed straight ileoanal pull-throughs. Dis Colon Rectum 34(11):1040–1042
Alexander F (2007) Complications of ileal pouch anal anastomosis. Semin Pediatr Surg 16(3):200–204
Mattioli G, Palomba L, Avanzini S, Rapuzzi G, Guida E, Costanzo S, Rossi V, Basile A, Tamburini S, Callegari M, DellaRocca M, Disma N, Mameli L, Montobbio G, Jasonni V (2009) Fast-track surgery of the colon in children. J Laparoendosc Adv Surg Tech A 19(Suppl):S7–S9
Reismann M, von Kampen M, Laupichler B, Suempelmann R, Schmidt AI, Ure BM (2007) Fast-track surgery in infants and children. J Pediatr Surg 42(1):234–238
Watkins AC, White PF (2001) Fast-tracking after ambulatory surgery. J Perianesth Nurs 16(6):379–387
Lillehei CW (2007) Ileal pouch-anal anastomosis for ulcerative colitis: technical considerations. Semin Pediatr Surg 16(3):194–199
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mattioli, G., Pini-Prato, A., Barabino, A. et al. Laparoscopic approach for children with inflammatory bowel diseases. Pediatr Surg Int 27, 839–846 (2011). https://doi.org/10.1007/s00383-011-2885-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-011-2885-5