C. Pisano1, I. Sapci1, P. Karam1, M. M. Costedio1, A. L. DeRoss1 1Cleveland Clinic,Digestive Disease Institute/Department Of Pediatric Surgery And Colorectal Surgery,Cleveland, OH, USA
Introduction: Inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis are relapsing gastrointestinal disorders commonly presenting in pediatric patients. Due to the chronic nature of these diseases, children with IBD need life-long follow-up, often requiring surgical management. While presenting symptoms are similar, the needs and expectations of treatment may differ between adult and pediatric patients. Patients initially require operations performed by pediatric surgeons, but are then followed by adult colorectal surgeons after the age of 18. The varied age of this population may cause difficulties in surgical management and continuity of care is not always well established. This may create frustration for patients and healthcare providers. There have been models in other fields establishing transitional care from the pediatric to the adult patient. However, there has been little mention of similar efforts in surgery. A collaborative system involving both pediatric and colorectal surgeons may add expertise and improve the overall experiences for pediatric colorectal patients. We hypothesized that surgeries performed in partnership with both pediatric and adult colorectal surgeons may lead to better outcomes for these patients.
Methods: Data was gathered retrospectively from patients 18 years old or younger who underwent colorectal resections for inflammatory bowel disease between 2010 and 2017 at a single institution. Data included patient demographics (age, gender, BMI, disease, steroid or biologic agent use), type of procedure, surgical approach, specimen extraction site, surgeon involvement (pediatric, colorectal or collaboration), operative time, and estimated blood loss. We analyzed days until passage of flatus and bowel movement, length of stay, type of surgical procedure, and surgical complications.
Results: A total of 117 patients were included in our study. Our data showed that days until flatus (2.27±0.47, p=0.049), first bowel movement (2.64±0.67, p=0.006) and length of stay (4.45±1.51, p=0.006) were the least in collaboration group. Single-incision laparoscopic surgery (SILS), compared to other laparoscopic techniques, was utilized most commonly in collaborative group (77.8% p=0.002). We did not see differences in surgical complication rates when comparing any of the groups.
Conclusion: Our results show improved outcomes in pediatric patients with inflammatory bowel disease when there was collaboration between pediatric and colorectal surgeons in comparison to surgeries performed by pediatric surgeons or adult colorectal surgeons alone. Such structured cooperation may benefit transition of care and other aspects of long-term management in this patient population.
