title: Laparoscopic-assisted bowel resection in pediatric/adolescent inflammatory bowel disease: laparoscopic bowel resection in children.
abstract: OBJECTIVE
  The purpose of this study is to discuss indications, technical approach, and morbidity of laparoscopic approaches to major bowel resection in the pediatric/adolescent population with inflammatory bowel disease and familial polyposis.
  
  
  METHODS
  Retrospective review of laparoscopic-assisted bowel procedures between May 1991 and January 2002 was performed. Laparoscopic-assisted bowel resection is defined as complete intracorporeal mobilization and devascularization of a segment of colon or rectum. The indications for extracorporeal vs. intracorporeal anastomosis will be discussed. Clinically unstable, septic, or massively bleeding patients were not candidates for this technique. The decision to attempt the laparoscopic approach was based on the experience of the consulting surgeon. There were 31 patients, including 14 females. Five patients had undergone prior surgery. Twenty-nine patients had inflammatory bowel disease, one had familial polyposis, and one had a cavernous hemangioma. We included all pediatric/adolescent patients in our practice undergoing laparoscopic resection.
  
  
  RESULTS
  Twenty-nine patients had 33 laparoscopic operations, including proctocolectomy with ileal pouch-anal anastomosis (n = 14), proctocolectomy with ileostomy (n = 3), ileocolectomy with ileocolic anastomosis (n = 13), and small-bowel obstruction (n = 1). Average operating time was 158 (range, 30-400) minutes, with average blood loss of 159 ml. Average wound length was 4.9 cm. The complication rate was 16 percent (n = 5), with one anastomotic leak. The rate of conversion to open operations was 5.8 percent. Liquid diet was begun on Day 3, and the average length of stay was 5.9 days.
  
  
  CONCLUSIONS
  Major laparoscopic bowel surgery can be performed safely in the pediatric/adolescent population, with reasonable operative times, low conversion to open operations, and low morbidity.
authors.affiliation: Georgia Colon and Rectal Surgical Associates, Atlanta, Georgia 30342, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Simon
authors.forename: Guy
authors.initials: G
authors.lastname: Orangio
authors.forename: Wayne
authors.initials: W
authors.lastname: Ambroze
authors.forename: Marion
authors.initials: M
authors.lastname: Schertzer
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
mesh_terms: D000293:Adolescent; D002648:Child; D003082:Colectomy; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies