Outcomes of laparoscopic and open total colectomy in the pediatric population.
BACKGROUND
Total colectomy, performed either with proctecomy and ileal pouch anal anastomosis or with ileorectostomy, is standard for pediatric patients with ulcerative colitis or familial adenomatous polyposis syndrome, respectively. The complication rates from adult series have been reported to be as high as 40%-50%. We audited our experience to define the complication rates in children and determine whether the use of laparoscopy has the potential to lessen the number or change the type of complications.


METHODS
We conducted a retrospective review of all pediatric patients who underwent total colectomy with either proctectomy with ileal pouch anal anastomosis or with ileorectostomy at a single institution from 1998 to 2008. Data are expressed as mean +/- standard deviation. Continuous variables were analyzed using a Student's t-test; and discrete variables were analyzed using a Fisher's exact test, where appropriate. Significance was set as P < or = 0.05.


RESULTS
Forty-four patients aged 58 days to 18 years (mean 11.7 +/- 5.3 years) underwent total colectomy from 1998 to 2008. The indications for surgery were ulcerative colitis (27), familial adenomatous polyposis syndrome (11), total colonic Hirschprungs (2), and others (3). Follow-up was significantly greater in the open group (2.8 years) than in the laparoscopic group (1.1 years, P = 0.02). Nineteen patients (43%) suffered major complications (other than pouchitis). There was 1 anastomotic leak. There were no statistically significant differences found between the laparoscopic and open approaches with regard to postoperative small bowel obstruction, postoperative abdominal or pelvic abscess, anal stricture requiring dilation, wound infection, other complications, or time to complication. Patients who underwent laparoscopic ileal pouch anal anastomosis had one occurrence of pouchitis (1/10) compared with 19/34 in the open group (P = 0.03).


CONCLUSIONS
This series demonstrates that laparopscopic colectomy yields similar outcomes as the traditional open method, both in type and severity of complications. Patients who had an ileal pouch created through the laparoscopic approach had fewer occurrences of pouchitis.
Fraser
Jason D
JD
Department of Surgery, Children's Mercy Hospital , Kansas City, MO 64108, USA.
Garey
Carissa L
CL
Laituri
Carrie A
CA
Sharp
Ronald J
RJ
Ostlie
Daniel J
DJ
St Peter
Shawn D
SD
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000601:surgery*; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome