P434 Surgery management of Crohn's disease in children: our experience
G. Pujol Muncunill*1, J. González Pérez1, L. Saura García2, A. I. Pascual Pérez1, V. Vila Miravet1, X. Tarrado Castellarnau2, J. Martin de Carpi1
1Hospital Sant Joan de Déu, Unit for Comprehensive Care of Pediatric Inflammatory Bowel Disease, Pediatric Gasatroneterology, Hepatology and Nutrition Unit, Barcelona, Spain, 2Hospital Sant Joan de Déu, Unit for the Comprehensive Care of Pediatric Inflammatory Bowel Disease, Department of Pediatric Surgery, Barcelona, Spain
Classically, surgical treatment in paediatric Crohn's disease (CD) was the last option after the failure of available medical treatments. Currently, surgery is offered in patients with localised inflammatory activity despite optimised medical treatment or in patients with complications of the disease in early stages. The aim of our study is to review our experience to know the phenotype of patients who need surgery, surgical technique used and short- and medium-term results.
Retrospective cohort study of patients with paediatric CD who underwent surgery (excluding surgery of perianal disease) between 2012 and 2017 in a tertiary paediatric hospital. Epidemiological, clinical, analytical, radiological, endoscopic and surgical variables were collected and analysed.
Twenty-five patients had required surgical treatment (52% males). Mean age at diagnosis was 11.6 ± 2.5 years, with a median (IQR) from the onset of symptoms to diagnosis of 0.74 (1) years. Mean time from diagnosis to the date of surgery was 2.5 ± 2 years. Forty per cent had a structuring behaviour at debut, 4% penetrating and 12% both of them. The most frequent location was ileocolonic (60%). Regarding the treatments received before surgery, 68% had received exclusive enteral nutrition and immunosuppressives, 20% corticosteroids and immunosuppressives, 20% anti-TNF-α treatment in monotherapy and 84% biological treatment (anti-TNFα/vedolizumab/ustekinumab) with immunosuppressives. The most frequent surgical indication was recurrent intestinal obstruction (84%). All interventions were initiated by laparoscopy although 12% were converted to laparotomy. Eighty-four per cent of the patients had a single resection, 8% multiple resections, and in the remaining an ileostomy without resection was performed. Ileocaecal area was resected in 78.3% of the patients and in 2 patients a single strictureplasty was performed. Mean surgical time was 3.8 ± 1.2 h and the average number of days of admission was 8.2 ± 3.3. There were no cases of surgical wound infection or postoperative ileus. For prevention of postoperative recurrence, 96% of patients received biological treatment (anti-TNF-α, ustekinumab) ± immunosuppressives. To date, endoscopic control has been performed in 13 patients (between 6 and 12 months after surgery) with the following Rutgeerts index: i0 46.1%; i1 30.8%; i2 15.4%; i4 7.7%. At follow-up, one patient required surgical re-intervention.
Although new biological treatments has reduced the need of surgery in paediatric Crohn’s disease, a surgical approach by experienced teams, could be an effective and safe alternative in selected cases with complicated disease or unresponsive to medical treatment.