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http://dx.doi.org/10.5223/pghn.2017.20.1.14

Surgery in Pediatric Crohn's Disease: Indications, Timing and Post-Operative Management  

Kim, Seung (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
Publication Information
Pediatric Gastroenterology, Hepatology & Nutrition / v.20, no.1, 2017 , pp. 14-21 More about this Journal
Abstract
Pediatric onset Crohn's disease (CD) tends to have complicated behavior (stricture or penetration) than elderly onset CD at diagnosis. Considering the longer duration of the disease in pediatric patients, the accumulative chance of surgical treatment is higher than in adult onset CD patients. Possible operative indications include perianal CD, intestinal stricture or obstruction, abdominal abscess or fistula, intestinal hemorrhage, neoplastic changes and medically untreatable inflammation. Growth retardation is an operative indication only for pediatric patients. Surgery can affect a patient's clinical course, especially for pediatric CD patient who are growing physically and mentally, so the decision should be made by careful consideration of several factors. The complex and diverse clinical conditions hinder development of a systemized treatment algorithm. Therefore, timing of surgery in pediatric CD patients should be determined with individualized approach by an experienced and well organized multidisciplinary inflammatory bowel disease team. Best long-term outcomes will require proactive post-operative monitoring and therapeutic modifications according to the conditions.
Keywords
Inflammatory bowel diseases; Crohn disease; Colorectal surgery; Child;
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1 Singh Ranger G, Lamparelli MJ, Aldridge A, Chong SK, Mitton SG, Albanese A, et al. Surgery results in significant improvement in growth in children with Crohn's disease refractory to medical therapy. Pediatr Surg Int 2006;22:347-52.   DOI
2 Yu JX, East JE, Kaltenbach T. Surveillance of patients with inflammatory bowel disease. Best Pract Res Clin Gastroenterol 2016;30:949-58.   DOI
3 Farraye FA, Odze RD, Eaden J, Itzkowitz SH. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology 2010;138:746-74, 774.e1-4.   DOI
4 Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med 2010;362:1383-95.   DOI
5 Buisson A, Chevaux JB, Allen PB, Bommelaer G, Peyrin-Biroulet L. Review article: the natural history of postoperative Crohn's disease recurrence. Aliment Pharmacol Ther 2012;35:625-33.   DOI
6 Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990;99:956-63.   DOI
7 Hashash JG, Regueiro MD. The evolving management of postoperative Crohn's disease. Expert Rev Gastroenterol Hepatol 2012;6:637-48.   DOI
8 Regueiro M. Management and prevention of postoperative Crohn's disease. Inflamm Bowel Dis 2009;15:1583-90.   DOI
9 Domenech E, Manosa M, Lobaton T, Cabre E. Optimizing post-operative Crohn's disease treatment. Ann Gastroenterol 2014;27:313-9.
10 Danese S. New therapies for inflammatory bowel disease: from the bench to the bedside. Gut 2012;61:918-32.   DOI
11 Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 2015;110:1324-38.   DOI
12 de Groof EJ, Buskens CJ, Bemelman WA. Single-port surgery in inflammatory bowel disease: a review of current evidence. World J Surg 2016;40:2276-82.   DOI
13 Smith NP, Ba'ath ME, Perry D, Morgan LE, Lamont GL, Baillie CT. BAPS UK inflammatory bowel disease surgical practice survey. J Pediatr Surg 2007;42:296-9.   DOI
14 Hyams JS, Griffiths A, Markowitz J, Baldassano RN, Faubion WA Jr, Colletti RB, et al. Safety and efficacy of adalimumab for moderate to severe Crohn's disease in children. Gastroenterology 2012;143:365-74.e2.   DOI
15 Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis 2011;17:1314-21.   DOI
16 Gower-Rousseau C, Vasseur F, Fumery M, Savoye G, Salleron J, Dauchet L, et al. Epidemiology of inflammatory bowel diseases: new insights from a French population-based registry (EPIMAD). Dig Liver Dis 2013;45:89-94.   DOI
17 El-Asmar K, El-Shafei E, Abdel-Latif M, AbouZeid A, El-Behery M. Surgical aspects of inflammatory bowel diseases in pediatric and adolescent age groups. Int J Colorectal Dis 2016;31:301-5.   DOI
18 Na SY, Shim JO. Biological therapy for inflammatory bowel disease in children. Pediatr Gastroenterol Hepatol Nutr 2012;15:13-8.   DOI
19 Lakatos PL, Golovics PA, David G, Pandur T, Erdelyi Z, Horvath A, et al. Has there been a change in the natural history of Crohn's disease? Surgical rates and medical management in a population-based inception cohort from Western Hungary between 1977-2009. Am J Gastroenterol 2012;107:579-88.   DOI
20 Gupta N, Cohen SA, Bostrom AG, Kirschner BS, Baldassano RN, Winter HS, et al. Risk factors for initial surgery in pediatric patients with Crohn's disease. Gastroenterology 2006;130:1069-77.   DOI
21 Hatch QM, Ratnaparkhi R, Althans A, Keating M, Neupane R, Nishtala M, et al. Is modern medical management changing ultimate patient outcomes in inflammatory bowel disease? J Gastrointest Surg 2016;20:1867-73.   DOI
22 Bhakta A, Tafen M, Glotzer O, Ata A, Chismark AD, Valerian BT, et al. Increased incidence of surgical site infection in IBD patients. Dis Colon Rectum 2016;59:316-22.   DOI
23 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;11:157-64.   DOI
24 Seifarth C, Kreis ME, Grone J. Indications and specific surgical techniques in Crohn's disease. Viszeralmedizin 2015;31:273-9.
25 Scott N, Hughes L. Timing of ileocolonic resection for symptomatic Crohn's disease--the patient's view. Gut 1994;35:656-7.   DOI
26 Hansen LF, Jakobsen C, Paerregaard A, Qvist N, Wewer V. Surgery and postoperative recurrence in children with Crohn disease. J Pediatr Gastroenterol Nutr 2015;60:347-51.   DOI
27 Pariente B, Cosnes J, Danese S, Sandborn WJ, Lewin M, Fletcher JG, et al. Development of the Crohn's disease digestive damage score, the Lemann score. Inflamm Bowel Dis 2011;17:1415-22.   DOI
28 Keljo DJ, Markowitz J, Langton C, Lerer T, Bousvaros A, Carvalho R, et al. Course and treatment of perianal disease in children newly diagnosed with Crohn's disease. Inflamm Bowel Dis 2009;15:383-7.   DOI
29 Baillie CT, Smith JA. Surgical strategies in paediatric inflammatory bowel disease. World J Gastroenterol 2015;21:6101-16.   DOI
30 Alos R, Hinojosa J. Timing of surgery in Crohn's disease: a key issue in the management. World J Gastroenterol 2008;14:5532-9.   DOI
31 de Zoeten EF, Pasternak BA, Mattei P, Kramer RE, Kader HA. Diagnosis and treatment of perianal Crohn disease: NASPGHAN clinical report and consensus statement. J Pediatr Gastroenterol Nutr 2013;57:401-12.   DOI
32 Panes J, Garcia-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, et al. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet 2016;388:1281-90.   DOI
33 Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB; American Gastroenterological Association Clinical Practice Committee. AGA technical review on perianal Crohn's disease. Gastroenterology 2003;125:1508-30.   DOI
34 Halme L, Sainio AP. Factors related to frequency, type, and outcome of anal fistulas in Crohn's disease. Dis Colon Rectum 1995;38:55-9.   DOI
35 Regueiro M, Mardini H. Treatment of perianal fistulizing Crohn's disease with infliximab alone or as an adjunct to exam under anesthesia with seton placement. Inflamm Bowel Dis 2003;9:98-103.   DOI
36 Strong S, Steele SR, Boutrous M, Bordineau L, Chun J, Stewart DB, et al. Clinical practice guideline for the surgical management of Crohn's disease. Dis Colon Rectum 2015;58:1021-36.   DOI
37 Di Nardo G, Oliva S, Passariello M, Pallotta N, Civitelli F, Frediani S, et al. Intralesional steroid injection after endoscopic balloon dilation in pediatric Crohn's disease with stricture: a prospective, randomized, doubleblind, controlled trial. Gastrointest Endosc 2010;72:1201-8.   DOI
38 Hagel AF, Hahn A, Dauth W, Matzel K, Konturek PC, Neurath MF, et al. Outcome and complications of endoscopic balloon dilatations in various types of ileocaecal and colonic stenosis in patients with Crohn's disease. Surg Endosc 2014;28:2966-72.   DOI
39 Michelassi F, Balestracci T, Chappell R, Block GE. Primary and recurrent Crohn's disease. Experience with 1379 patients. Ann Surg 1991;214:230-8; discussion 238-40.   DOI
40 Pfefferkorn MD, Marshalleck FE, Saeed SA, Splawski JB, Linden BC, Weston BF. NASPGHAN clinical report on the evaluation and treatment of pediatric patients with internal penetrating Crohn disease: intraabdominal abscess with and without fistula. J Pediatr Gastroenterol Nutr 2013;57:394-400.   DOI
41 Garcia JC, Persky SE, Bonis PA, Topazian M. Abscesses in Crohn's disease: outcome of medical versus surgical treatment. J Clin Gastroenterol 2001;32:409-12.   DOI
42 Kim KJ, Han BJ, Yang SK, Na SY, Park SK, Boo SJ, et al. Risk factors and outcome of acute severe lower gastrointestinal bleeding in Crohn's disease. Dig Liver Dis 2012;44:723-8.   DOI
43 Papi C, Gili L, Tarquini M, Antonelli G, Capurso L. Infliximab for severe recurrent Crohn's disease presenting with massive gastrointestinal hemorrhage. J Clin Gastroenterol 2003;36:238-41.   DOI
44 Podugu A, Tandon K, Castro FJ. Crohn's disease presenting as acute gastrointestinal hemorrhage. World J Gastroenterol 2016;22:4073-8.   DOI
45 Vasseur F, Gower-Rousseau C, Vernier-Massouille G, Dupas JL, Merle V, Merlin B, et al. Nutritional status and growth in pediatric Crohn's disease: a population-based study. Am J Gastroenterol 2010;105:1893-900.   DOI
46 Ruemmele FM, Veres G, Kolho KL, Griffiths A, Levine A, Escher JC, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohns Colitis 2014;8:1179-207.   DOI
47 Malik S, Mason A, Bakhshi A, Young D, Bishop J, Garrick V, et al. Growth in children receiving contemporary disease specific therapy for Crohn's disease. Arch Dis Child 2012;97:698-703.   DOI