P424 Surgery for children with Crohn’s disease.
M. Stefanowicz*1, H. Ismail1, G. Kowalewski1, A. Kowalski1, J. Kierkuś2, P. Kaliciński1
1Children’s Memorial Health Institute, Department of Paediatric Surgery and Organ Transplantations, Warszawa, Poland, 2Children’s Memorial Health Institute, Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, Warszawa, Poland
Crohn’s disease (CD) in children is often more extensive and has a more aggressive course than in adults. CD recurs after surgery, and more than 70% of patients will require reoperation. Aim: to analyse factors affecting the goals of treatment and choice of surgical procedure and to evaluate the effects of surgical treatment on early and long-term results.
We conducted a retrospective analysis of treatment in 113 patients who underwent surgery for CD between 1999 and 2015. Patients were divided into 2 groups depending on the purpose and type of surgery performed. In group I (n = 69), the goal of treatment was to remove all involved bowel. They underwent bowel resection and primary anastomosis. Ileo-caecal resection was done in 90% of them. In group II (n = 44), the goal of the treatment was to achieve remission in the affected bowel or to control acute life-threatening complications of the disease by excluding the peripheral portion of the intestine. Ileostomy was performed in 35; colostomy in 9; and 30 patients underwent segmental resection of the bowel. Long-term results were evaluated in 79 patients with follow-up of more than 12 months.
The main factor influencing the choice of surgical procedure was the location of the disease. In CD located outside the colon (L1 + L4) primary anastomosis was performed more frequently. In CD localised in the large intestine (L2 + L3) faecal diversion was required more often. In group I, primary anastomosis was safe and was associated with low number of early complications. No one required surgery for recurrence of the disease in the anastomotic site. Intestinal continuity is preserved in 90% of patients. The number of patients in remission before and after surgery increased from 36% to 94%. A reduction in the number of patients with growth delay was observed (34% vs 8.5%). Z-score and BMI significantly improved between pre- and postoperative measurement. In group II remission was obtained in 84%. The number of patients with growth delay before and after surgery decreased from 37.5% to 18.8%. Z-score and BMI were higher compared with the results before surgery. In 81% of patients, it was impossible to restore the continuity of the GI tract.
In patients with localised and limited CD, resection of the involved bowel and primary anastomosis was safe and resulted in remission, improvement in growth and nutritional status, and has been associated with preservation of intestinal continuity in most patients. Even though partial exclusion of the GI tract in CD allows for the control of acute life-threatening complications and for achieving remission in the affected intestinal segment in most patients, in majority of them, it is impossible to restore the continuity of the GI tract.