Surgery in children with Crohn disease refractory to medical therapy.
OBJECTIVE
The aim of this study was to evaluate the results of surgery in children with Crohn disease (CD) not responding to medical therapy and establish whether surgery improves growth and nutrition.


METHODS
Children with CD diagnosed between 1998 and 2008 were reviewed. Relapse was defined by Harvey-Bradshaw index >5. Data, reported as median (range), were compared by Fisher exact test and repeated-measures ANOVA.


RESULTS
One hundred forty-one children, ages 12.7 years (3.5-16.8), were identified; 27 (19%) required surgery 14.5 months (1.1-61.8) after diagnosis. Twenty-one had elective surgery (19 isolated ileocaecal disease and stricture, 2 diffuse disease of ileum); 6 had emergency surgery (3 peritonitis, 2 haemorrhage, 1 perforation). Surgery included 18 ileocaecal resection and end-to-end anastomosis, 5 stoma formation, 2 left hemicolectomy and end-to-end anastomosis, and 2 stricturoplasty. Follow-up was 2.5 years (1-9.4). Growth and nutrition improved by 6 and 12 months after surgery, with a significant increase in weight z score (P < 0.0001), height z score (P < 0.0001), albumin (30 [13-36] vs 39 [30-46] vs 40 [33-45], P < 0.0001), and haemoglobin [10 (6.8-13.2) vs 11.7 (8.2-13.7) vs 12.0 (9.3-14.7), P < 0.0001]. All patients of the received azathioprine (2-2.5 mg · kg⁻¹ · day⁻¹) after surgery. Fifteen patients (55%) relapsed with a modified Harvey-Bradshaw index of 8 (6-11) within 11.5 months (4.2-33.4). Of these, 5 patients (18%) relapsed within 1 year. Five patients (18%) had further surgery (2 anastomotic strictures, 2 diseased stoma, and 1 enterocutaneous fistula).


CONCLUSIONS
Growth and nutrition following surgery for CD improve, but there is a high relapse rate. Despite this, the improved growth and nutrition before relapse may be beneficial during puberty and justify surgery in children not responding to medications.
Pacilli
Maurizio
M
Pediatric Surgery Unit, Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
Eaton
Simon
S
Fell
John M
JM
Rawat
David
D
Clarke
Simon
S
Haddad
Munther J
MJ
D000293:Adolescent; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D006128:Growth; D006130:Growth Disorders / Q000209:etiology* / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D012008:Recurrence; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome; D015430:Weight Gain
D006454:Hemoglobins; D012709:Serum Albumin