Long-term Improvement After Ileocecetomy in Pediatric Crohn’s Disease
*Julie Monteagudo1, *Hans M Huber2, *Catherine M Dickinson2, *Jason Shapiro2, Francois I Luks2
1Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI;2Alpert Medical School of Brown University, Providence, RI
Objective: Surgical intervention for Crohn's disease (CD) has been mostly limited to treatment of complications, such as abscess formation, severe strictures and fistulas. Escalation of medical therapy is often the only option, but growth and nutrition maintenance remain difficult. In severe disease limited to the terminal ileum, ileocecectomy can be offered, but the long-term results are not fully known. We hypothesize that ileocectomy for ileal CD is safe and offers good long-term outcomes including sustained weight gain and medical de-escalation.
Design: Retrospective study
Setting: Tertiary children's hospital
Patients: Males and females ≤18 years with CD
Main Outcome Measures: Weight gain
Results: 33 children from 3 to 18 years (median 15 years) underwent an ileocecectomy. Median duration of illness prior to operation was 26 months (2-119 months). Six months postoperatively, median weight gain for the entire cohort was 4.6 kg; median BMI gain was 1.4 kg/m2. All but 2 of the 16 patients who were initially underweight (BMI ≤18.5) gained weight postoperatively (figure; p<0.05, Wilcoxon Rank Sum) (figure), from BMI of 16.5 ± 1.0 to 18.2 ± 2.1, p<0.01, Student t). Thirteen of 28 patients could be taken off anti-inflammatory medication. Only five patients required any additional surgical intervention (average follow-up 39 months).
Conclusions: Ileocectomy for Crohn’s disease limited to the terminal ileum is safe and effective, leading to durable postoperative weight gain in most patients. Complications are rare and very few patients require reoperations on long-term follow-up. Almost half the patients could be weaned off anti-inflammatory medication.
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