Outcomes after staged surgical treatment of children with ileocecal lesions and active extensive inflammation in Crohn’s disease

Abstract

   Introduction. Crohn’s disease is characterized with transmural lesion of the gastrointestinal tract which is frequently localized in the ileocecal region. Despite the achievements in medicamentous therapy, 15–45% of children have to be operated on within 5 years after the diagnosis is verified.   Purpose. To substantiate the efficacy of two-stage surgical treatment of children with Crohn’s disease , ileocecal lesion and active extensive inflammation.   Material and methods. A single-stage retrospective-prospective study included 43 children with ileocecal lesions and advanced colitis. Two-stage surgical treatment was performed. In the preoperative period, the following parameters were assessed: physical state, clinical activity, anemia and the level of hypoalbuminemia as well as inflammation markers, findings at endoscopy and MRI. Indications for surgical treatment were strictures in the ileocecal region, endoscopic and clinical activity and colon lesion and / or purulent-septic lesions in the perianal region. 39 (90.7 %) children had laparoscopically-assisted surgeries. 4 (9.3 %) children underwent conversions due to a pronounced infiltrative process in the abdominal cavity.   Results. Lengths of hospitalization for children with stoma varied from 5 to 20 months (median 8 months). PCDAI index: in 25 (57.8 %) high activity, in 18 (41.2 %) moderate activity. After surgical intervention: 7 (16.2%) children had mild course, 36 children (p 0.05) SES-CD before surgery – all children had high endoscopic activity. In the postoperative period by Rutgeerts scale findings, there was a statistically significant positive dynamics (p = 0.011). Anthropometric parameters (HAZ p 0.05; BAZ p 0.001) and laboratory findings (p 0.001) were statistically significant for positive dynamics too.In the postoperative period: 5 (11.6 %) children developed ligature fistulas; 2 children (4.6 %) had narrowed intestinal anastomosis without passage disorders; 2 (4.6 %) children developed acute adhesive intestinal obstruction. In foreign and Russian publications, postoperative complications were reported in 6 % to 29 %.   Conclusions. Crohn’s disease has led to chronic anemia, hypoalbuminemia, chronic bacterial inflammation, reduced physical growth and worsen quality of life. After the two-stage surgical treatment, the statistical analysis demonstrated a significant improvement in mass-growth, laboratory and endoscopic parameters.