A comparative analysis and choice of surgical tactics in pediatric Crohn’s disease
- Authors: Poddubniy I.V.1,2, Scherbakova O.V.3, Trunov V.O.3, Kozlov M.Y.1, Manukyan S.R.1,2, Galkina Y.A.1
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Affiliations:
- Morozovskaya Children’s Clinical Hospital
- А.I. Evdokimov Moscow University of Medicine and Dentistry
- Pirogov Russian Medical University
- Issue: Vol 26, No 2 (2022)
- Pages: 69-73
- Section: ORIGINAL STUDY
- Submitted: 21.06.2022
- Accepted: 21.06.2022
- Published: 21.06.2022
- URL: https://jps-nmp.ru/jour/article/view/459
- DOI: https://doi.org/10.55308/1560-9510-2022-26-2-69-73
- ID: 459
Cite item
Abstract
Introduction. Currently, surgical complications in Crohn’s disease is still one of the most serious problems in pediatric surgery. An intensive development of video endoscopic surgery contributes to the active introduction of this technology in pediatric coloproctological practice. Crohn’s disease is still one of the most complex pathologies in pediatric gastroenterology, and surgical treatment of its complications is a disputable issue among pediatric surgeons. Up to now, there are no clear indications to surgery in the refractory form of Crohn’s disease, no standardized terms and types for surgical intervention, as well as no optimal variants of surgical access.
Material and methods. A retrospective analysis of patients who had been treated surgically at departments of abdominal and emergency surgery in two pediatric hospitals in Moscow (Morozovskaya and Izmailovskaya ) was carried out. 39 children with Crohn’s disease, aged 4–17 year, were included in the study. All patients had standard clinical examination: clinical examination with anamnesis, laboratory and instrumental diagnostics.
Results. The obtained results have shown that laparoscopic interventions have a number of advantages, such as less traumatic surgery, reduced exposure to anesthesia and shorter intestinal stimulation, less stay in ICU, shorter hospitalization as well as more rapid rehabilitation period.
Conclusion. The performed assessment of outcomes after surgical treatment of children with complicated Crohn’s disease helped to develop indications for the selection of surgical technique in the ileocecal form. Thus, the obtained results improved outcomes in children with complicated Crohn’s disease because of the outlined indications for surgery and surgical tactics when minimally invasive techniques are more preferable.
Keywords
About the authors
I. V. Poddubniy
Morozovskaya Children’s Clinical Hospital; А.I. Evdokimov Moscow University of Medicine and Dentistry
Author for correspondence.
Email: igorpoddubnyi@yandex.ru
Igor V. Poddubniy, professor, head of chair of pediatric surgery
Moscow, 127473
Moscow, 119049
РоссияO. V. Scherbakova
Pirogov Russian Medical University
Email: fake@neicon.ru
Moscow, 117997
РоссияV. O. Trunov
Pirogov Russian Medical University
Email: fake@neicon.ru
Moscow, 117997
РоссияM. Yu. Kozlov
Morozovskaya Children’s Clinical Hospital
Email: fake@neicon.ru
Moscow, 127473
РоссияS. R. Manukyan
Morozovskaya Children’s Clinical Hospital; А.I. Evdokimov Moscow University of Medicine and Dentistry
Email: fake@neicon.ru
Moscow, 127473
Moscow, 119049
РоссияYa. A. Galkina
Morozovskaya Children’s Clinical Hospital
Email: fake@neicon.ru
Moscow, 127473
РоссияReferences
- Белоусова Е.А., Морозова Н.А., Цодикова О.М., Сташук Г.А., Гаганов Л.Е. Отдаленные результаты лечения болезни Крона инфликсимабом . Экспериментальная и клиническая гастроэнтерология. 2015; 5(117): 76.
- Ивашкин В.Т., Шелыгин Ю.А., Халиф И.Л., Белоусова Е.А., Шифрин О.С., Абдулганиева Д.И. и др. Клинические рекомендации Российской гастроэнтерологической ассоциации и ассоциации колопроктологов России по диагностике и лечению болезни Крона. Колопроктология. 2017; 2(60): 7–29.
- Шелыгин Ю. А., ред. Колопроктология. Клинические рекомендации. М.: ГЭОТАР-Медиа; 2015.
- Главнов П.В., Лебедева Н.Н., Кащенко В.А., Варзин С.А. Язвенный колит и болезнь Крона. Современное состояние, проблемы этиологии, ранней диагностики и лечения. Вест. СПбГУ. 2015; 11(4): 48–72.
- Barkmeier D.T., Dillman J.R., Al-Hawary M., Heider A., Davenport M.S., Smith E.A. et al. MR enterography-histology comparison in resected pediatric small bowel Crohn disease strictures: can imaging predict fibrosis? Pediatr. Radiol. Gomollon F., Dignass A., Annese V., Tilg H., Van Assche G., Lindsay J. O. et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management. J. Crohns Colitis. 2017; 11(1): 3–25.
- Bollegala N., Nguyen G.C. Transitioning the adolescent with IBD from pediatric to adult care: a review of the literature. Gastroenterol. Research Pract. 2015; 2015: 853530.
- Kammermeier J., Morris M.A., Garrick V., Furman M., Rodrigues A., Russell R.K. et al. Management of Crohn’s disease. Arch. Dis. Child. 2016; 101(5): 475–80.
- Поддубный И.В., Алиева Э.И., Трунов В.О., Козлов М.Ю., Галкина Я.А., Щербакова О.В., Сарычева А.А., Кулаев А . В . Мордвин П.А., Манукян С.Р. Эндохирургическое лечение болезни Крона, осложненной формированием илеосигмовидного свища у мальчика 10 лет. Детская хирургия. 2017; 21(4): 217–20. https://doi.оrg/10.18821/1560-9510-2017-21-4-220-2
- Щербакова О.В. Показания к хирургическому лечению детей с болезнью Крона. Воронеж: Издательство «Научная книга»; 2015.
- Lourenc R., Azevedo S., Lopes A.I. Surgery in Pediatric Crohn Disease: case series from a single tertiary referral center. GE Port. J. Gastroenterol. 2016; 23(4): 191–6.
- Щукина О.Б., Собко В.Ю., Горбачева Д.Ш., Григорян В.В., Васильев С.В. Показания к хирургическому лечению болезни Крона. Колопроктология. 2016; S1: 107. https://doi.org/10.1016/j.jpge.2016.03.007
- Шавров А.А., Харитонова А.Ю., Алиева Э.И., Шавров А.А. (мл.), Налбандян Р. Т. Возможности внутрипросветной эндоскопии при болезнях тонкой и толстой кишки у детей. Вопросы современной педиатрии. 2016; 11(3): 32–42. https://doi.org/10.20953/1817-7646-2016-3-32-42
- Dotson J.L., Bashaw H., Nwomeh B., Crandall W.V. Management of intra- abdominal abscesses in children with Crohn’s disease: a 12-year, retrospective single-center review. Inflamm. Bowel Dis. 2015; 21(5): 1109–14.
- Gionchetti P., Dignass A., Danese S., Magro Dias F. J., Rogler G., Lakatos P.L. et al. 3rd European Evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: Surgical management and special situations. J. Crohns Colitis. 2017; 11(2): 135–49.