Experience in the surgical management of children with complicated crohn's disease

Alexandr Bekin; Elena Dyakonova; Aleksey Gusev; Maxim Lokhmatov; Alexandr Potapov; Dmitriy Sladkov; Sergey Yatzik; Andrey Fisenko; Darya Pereladova

doi:10.5281/zenodo.10009810

Authors

Alexandr Bekin FSAI “National Medical Research Center of Children’s Health” MH RF, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia https://orcid.org/0000-0002-5900-1812
Elena Dyakonova FSAI “National Medical Research Center of Children’s Health” MH RF, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia https://orcid.org/0000-0002-8563-6002
Aleksey Gusev FSAI “National Medical Research Center of Children’s Health” MH RF, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia https://orcid.org/0000-0002-2029-7820
Maxim Lokhmatov FSAI “National Medical Research Center of Children’s Health” MH RF, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia https://orcid.org/0000-0002-8305-7592
Alexandr Potapov FSAI “National Medical Research Center of Children’s Health” MH RF, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia https://orcid.org/0000-0003-4905-2373
Dmitriy Sladkov N.F. Filatov Children’s City Hospital, Sadovaya-Kudrinskaya st. 15, 123001, Moscow, Russia https://orcid.org/0000-0003-2638-3727
Sergey Yatzik FSAI “National Medical Research Center of Children’s Health” MH RF, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia https://orcid.org/0000-0001-6966-1040
Andrey Fisenko FSAI “National Medical Research Center of Children’s Health” MH RF, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia https://orcid.org/0000-0001-8586-7946
Darya Pereladova Pirogov Russian National Research Medical University, st. Ostrovityanova, 1, 117997, Moscow, Russia https://orcid.org/0009-0006-6230-7886

DOI:

https://doi.org/10.5281/zenodo.10009810

Keywords:

Bowel stricture, Children, Crohn's disease, Laparoscopy, Surgical treatment

Abstract

Objective: To present experience in pre-surgical diagnosis, selection of surgical tactics and volume of intervention in different variants of gastrointestinal tract lesions and disease activity.

Materials and methods: We undertook cross-sectional, retrospective-prospective study of 64 children who underwent surgery due to complicated CD. We analyzed CD activity via PCDAI, medications used, inflammation localization, and changes in mass-growth parameters at pre-surgery stage.

Results: Three patients from the group of 44 children with two-stage surgical treatment later showed inefficacy of GEBD in post-operative period. The disease progression was revealed and, therefore, subtotal colectomy was required. Three children had secondary adhesion of surgical wounds by means of active immunosuppressive therapy at preoperative period, and five patients developed suture sinuses at post-operative period. Early adhesive intestinal obstruction was revealed in 3 (4.7%) cases, and they required re-surgery.

Conclusions: Personalized approach to the surgical treatment of children with complicated CD has shown its efficacy due to the small percentage of postoperative complications with re-surgery. There was significant improvement in mass-growth parameters, recovery of albumin levels, and anemia decrease in 96.9% of cases in the long-term postoperative period (6 months or more).

References

Kim HJ, Oh SH, Kim DY, Lee HS, Park SH, Yang SK, et al. Clinical Characteristics and Long-Term Outcomes of Paediatric Crohn's Disease: A Single-Centre Experience. J Crohns Colitis. 2017;11(2):157-64.

Tarnok A, Kiss Z, Kadenczki O, Veres G. Characteristics of biological therapy in pediatric patients with Crohn's disease. Expert Opin Biol Ther. 2019;19(3):181-96.

Dotlačil V, Škába R, Rousková B, Poš L, Kučerová B, Coufal Š, et al. Surgical treatment of Crohns disease in children in the era of biological treatment. Rozhl Chir. 2022;101(2):56-60.

Stewart D. Surgical care of the pediatric Crohn's disease patient. Semin Pediatr Surg. 2017;26(6):373-8.

Cantoro L, Lenti MV, Monterubbianesi R, Cicala M, Giannarelli D, Papi C, et al. Early-onset versus late-onset Crohn's disease: An Italian cohort study. United European Gastroenterol J. 2020;8(1):52-8.

Maccioni F, Bencardino D, Buonocore V, Mazzamurro F, Viola F, Oliva S, et al. MRI reveals different Crohn's disease phenotypes in children and adults. Eur Radiol. 2019;29(9):5082-92.

Bekin AS, D'yakonova EY, Surkov AN. Crohn's disease in children: the current state of the problem. Pediatriya im. G.N. Speranskogo. 2021;100(6):78-85.

Quiroz HJ, Perez EA, El Tawil RA, Willobee BA, Galvez-Cabezas K, Ferrantella AR, et al. Open Versus Laparoscopic Right Hemicolectomies in Pediatric Patients with Crohn's Disease. J Laparoendosc Adv Surg Tech A. 2020;30(7):820-5.

Hansen LF, Jakobsen C, Paerregaard A, Qvist N, Wewer V. Surgery and postoperative recurrence in children with Crohn disease. J Pediatr Gastroenterol Nutr. 2015;60(3):347-51.

Bekin AS, D'yakonova EY, Surkov AN. Complicated forms of Crohn's disease in children requiring surgical treatment. Detskaya Khirurgiya. Zhurnal im. Yu.F. Isakova [Russian]. 2022;26(1):21.

Newton L, Delbecque L, Coşkun U, Symonds T, Clegg J, Hunter T. A qualitative study to explore symptoms and impacts of pediatric and adolescent Crohn's disease from patient and caregiver perspective. J Patient Rep Outcomes. 2021;5(1):49.

Pini-Prato A, Faticato MG, Barabino A, Arrigo S, Gandullia P, Mazzola C, et al. Minimally invasive surgery for paediatric inflammatory bowel disease: Personal experience and literature review. World J Gastroenterol. 2015;21(40):11312-20.

Fehmel E, Teague WJ, Simpson D, McLeod E, Hutson JM, Rosenbaum J, et al. The burden of surgery and postoperative complications in children with inflammatory bowel disease. J Pediatr Surg. 2018;53(12):2440-3.

Adegbola SO, Pisani A, Sahnan K, Tozer P, Ellul P, Warusavitarne J. Medical and surgical management of perianal Crohn's disease. Ann Gastroenterol. 2018;31(2):129-39.

Shcherbakova OV, Razumovskij AJ. Indications for surgical treatment of children and adolescents with complicated Crohn's disease. Detskaja hirurgija. 2018;22(1):35-41.

Seemann NM, King SK, Elkadri A, Walters T, Fish J, Langer JC. The operative management of children with complex perianal Crohn's disease. J Pediatr Surg. 2016;51(12):1993-7.

Biko DM, Mamula P, Chauvin NA, Anupindi SA. Colonic strictures in children and young adults with Crohn's disease: Recognition on MR enterography. Clin Imaging. 2018;48:122-6.

Amil-Dias J, Kolacek S, Turner D, Pærregaard A, Rintala R, Afzal NA, et al. Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN. J Pediatr Gastroenterol Nutr. 2017;64(5):818-35.

Zimmerman LA, Saites CG, Bairdain S, Lien C, Zurakowski D, Shamberger RC, et al. Postoperative Complications in Children With Crohn Disease Treated With Infliximab. J Pediatr Gastroenterol Nutr. 2016;63(3):352-6.