S. Lo1, G. Beasley1, C. Jolley1, S. Islam1 1University Of Florida,Pediatric Surgery,Gainesville, FL, USA
Introduction:
The role for surgery in management of Crohn’s disease has diminished over the past few decades, with improved medical treatment. However, there remains a subset of patients who require an operation due to complications and frequently this intervention is delayed. The purpose of this study was to understand and identify which children would benefit from surgery and their outcomes.
Methods:
Retrospective review of 107 children who were seen at our institution over a 10-year period (6/2006 to 6/2016) for Crohn’s disease was performed. Data regarding demographics, presentation, disease course, phenotype and location, management, and complications. The cohort was divided into medically managed (medicine) vs. surgical therapy (surgery), and were compared using the students t-test for continuous, Fisher’s exact test for categorical, and the Mann – Whitney test for non-parametric data. P values of less than 0.05 were considered significant.
Results:
107 children and adolescents with Crohn’s disease were identified that met inclusion criteria. We noted no significant difference in gender, race, family history, insurance status, age at diagnosis, symptoms at diagnosis, initial management, and numbers of flares per year between the surgery group (n=29) and the medicine group (n=78). The surgery group had significantly more small bowel (90% vs. 72%, p=0.019) and stricturing variant of Crohn’s (52% vs. 6%, p<0.0001) than the medicine group. The surgery group had a trend to reduction in the average number of flares per year pre- and post-surgery (3.1 vs. 1.9, p=0.08). Patients with fistulizing disease were mostly managed medically.
Conclusions:
The number of patients undergoing surgery was low, and in our experience, those children did not have a more severe presentation. Patients with ileal (small bowel) location and the stricturing variant of the disease are the ones who required surgery, and they benefited from bowel resection. These data will be used to counsel patients and offer early surgery where indicated.
